Block: esidential J J Commercial J Name of E~uiidir g:
Lot: Mix Use Other i) r__ 1
# of Stories: AKA's:
Building Own anagement: U Telephone Number: ( )
Name: FAX:
Address:
On Site Contact:
Name: * Telephone Number:
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested J Yes
Visual Inspection Results:
Facade:
Inspected Debris
North /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2to1" 0>1"
South D N/A EYes ❑ No -No Visible/Fine Layer ❑%to 1" 0>1"
East ❑ N/A f4es ❑ No Flo Visible/Fine Layer 13Y2 to 1" 0>1"
West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0%to1" ❑>1"
Facade Description:
Roof
Debris: No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: [] No VSible/Fine Layer ❑'%z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: / / /2002 Inspection Team: Name: `~ Agency:
j Name: Agency:
NYC-WTC 000128511
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NYC-WTC_000128511Source: NYC Law Department, mirrored locally