NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
'-) C - (:-E;-'' \C
Block: Residents Commercial Name of Building:
Lot: I Mix UseI J Other
# of Stories: AKA's:
Building Own er anagement: Telephone Number: ( ) 33 ' 1 30-'
Name: \ \(. -- FAX:
Address:
On Site Contact:
1\
Name: t Telephone Number:
Building Owner Management Activities
Interior Survey Performed j Yes ❑ No
Exterior Survey Performed es [] No / ` t;A
General Clean Up ❑ Yes ❑ No Locations: J :v .€2 S/'t
ACM Clean Up ❑ Yes. No Locations: u
Air Monitoring ,'Yes ❑ No Locations: `-
Co ies All Reports and Data a ueste Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 1.N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1"
South N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" 0>1"
East ❑ N/A , Yes ❑ No .GNo Visible/Fine Layer ❑%to 1" 0>1"
West EN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1"
Facade Description:
Roof
Debris: Visible /Fine Layer ❑ Y2 to 1" ❑ > 1"
Description;
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: o Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: 01 Debris: [No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No ViSible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments r;-t....-
t
Date: / /2002 Inspection Team: Name: ,- L. c Agency: %C t
Name: Agency:
NYC-WTC 000128601
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