WTC Visual Survey Form
remise Addresa:
2 c Lam'
Block: 5• Residential jj Commercial N Ine of Builds :
Lot: Mix UseIJ Other a' V c..e - ocJ
# of Stories: \ AKA's: 2.L r K A m e s - t ?-T
Buildin Owper/Management: Telephone Number:; II
Name: (Oo \ o ov2 ~- V { cr'i FAX: P
Address:
On Site Con t: S ` ------------------------------------------------------------ -
Name: Sc c1..
, - Telephone Number.; P II
Building Owner ManagementctivItles
Interior Survey Performed es ❑ No
Exterior Survey Performed BYes ❑ No
General Clean Up Yes ❑ No Locations:
ACM Clean Up ❑ Yes,IgNo Locations:
Air Monitoring JYes❑ No locations:
Copies of All Reports and Data Reguestecf s
Visual Inspection Results:
Facade:
Inspected Debris
North /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
South N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ S4 to 1" O>1"
East ❑ N/A es ❑ No ( No Visible/Fine Layer ❑ % to 1" ❑ > 1"
West ❑ N/A Yes ❑ No gNo Visible/Fine Layer ❑ % to 1" []>J"
Facade Description:
Roof Est;
tt
Debris: ❑ No Visible /Fine yer [] %: to 1" 4=~'"" > 1" 'l•
Description:
Setbacks N/A ❑
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to V ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'/s to 1" ❑ >1"
Floor: Debris: ❑ No Visible/Fine Layer O % to 1" ❑ > I"
Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Comments
RAL_PN RA cp tJ1FiW v P
Date: t //2002 Inspection Team: Name: L Agency: Ec
Name: Agency:
NYC-WTC 000128648
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NYC-WTC_000128648Source: NYC Law Department, mirrored locally