Premise Address:
WTC Visual Survey Form ff 4 sd4
Block: Residential Commercial Name of B ildin :
Lot: Mix Use 0 OtherD Pt114 & y
# of Stories: ft, AKA's: - ;4.,z','
PII
-
Building O+Oner/Mana ement: Telephone Number:
Name: (,mza vt 1- - UP FAX: .-.-.-.-.-.-.-.-.-.-.-.-.-.
Address:
On Site Contact:
Name: ' "A S
Building Owner Management Activities
Telephone Number.
Interior Survey Performed es ❑ No
Exterior Survey Performed Yes ❑ No
General Clean Up [gYesD No Locations:
ACM Clean Up ❑ Yes tlo Locations:
Air Monitoring [des [] No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North N/A ❑ Yes [] No ❑ No Visible/Fine Layer ❑ a to 1" 0>1"
South EN/A ❑ Yes ❑ No O No Visible/Fine Layer ❑ % to 1" [3> 1"
East N/A ` 'Yes [] No tcj0 Visible/Fine Layer ❑ % to 1" [] > 1"
West [] N/A 4'Yes [] No No Visible/Fine Layer [] h to 1" [3 > 1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer '/: to 1" O> 1"
Description:
Setbacks N/A ❑
Floor. Debris: 0 No Visible/Fine Layer ❑ Va to 1" 0> 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ h to V 0> 1"
Floor: Debris: 0 No Visible/Fine Layer ❑ h to 1" 0> 1"
Floor: Debris: [] No Visible/Fine Layer ❑ Va to 1" 0> 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" 0> 1"
Comments
Date: f I )bi o02 Inspection Team: Name: (
Name:
t u TC tD,'t
Agency:
Agency:
r-:' J
NYC-WTC 000128646
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NYC-WTC_000128646Source: NYC Law Department, mirrored locally