l ®®t 334 WTC Visuait-Survev Form
remise Address:
Block: ResidentialD Comrnejcial Name of Building:
Lot: Mix Use 9 Other
# of t rtes: AKA's: -IW9 sc.
Building OwnerlManagemen • Telephone Number ( )
Name: VC °>Q -v w -J Cl9 FAX:
Address:
On Site Contact
Name: ' ' Telephone Number
Building Owner Management Activities
Interior Survey Performed Yes Q No
Exterior Survey Performed Yes [] No
General Clean Up Yes No Locations:
ACM Clean Up Yes No Locations:
Air Monitoring Yes 9 No Locations:
Copies of All Reports and Data RequestedD Yes
Visual Inspection Results:
North
Me
EIilMr
Inpocted
jyes No
De ris
Visible/Fine Layer 9 % to 1" 0>> 1'
es No
South
East
West
0 N/A
❑ N/A
Yes No
Yes No
o Visible/Fine Layer
No Visible/Fine Layer
No Visible/Fine Layer
h to 1'
% to 1'
% to 1"
BEl:'-
>10
1"
1'
Facade Description:
Roof
Debris: i o Visible /Fine Layer .=j 3% to 1' n > 1'
Description:
Setbacks WAD
Floor__ Debris: No Visible/Fine Layer ❑ 34 to 1' > 1'
Fir._ Debris: No Visible/Fine Layer [] 36 to 1" >10
Floor.___ Debris: No Visible/Fine Layer 3% to 1' >10
Floor: _ __ Debris: No Visible/Fine Layer 3% to 1' >10
Floor___ Debris: No Visible/Fine Layer V to 1' > 1'
Comments