WTC Visual Survey Form
remise Address:
Bloc • ResidentialD Commercial Name of Building:
Lot Mix UseD Other
# of Stories: AKA's:
Building Owner/Management Telephone Number {
Name: 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 No Locations:
Copies of All Reports and Data Requested DYes
Visual Inspection Results:
Inspected De ris
North es No o Visible/Fine Layer %to 1 >1'
South WA Yes No No Visible/Fine Layer %to V >1'
East N/A Yes No No Visible/Fine Layer % to? > 1'
West N/A Yes No No Visible/Fine Layer 3% to V > 1'
Facade Description:
Roof
Debris: MNo Visible /Fine Layer .D 'e to 1' D> 1'
Description:
Setbacks WAD
Floor:___ Debris: No Visible/Fine Layer % to 1'
Floor_ Debris: No Visible/Fine Layer % to1'
Floor.___ Debris: No Visible/Fine Layer '% to 1'
Floor_ Debris: No Visible/Fine Layer [] Ys to 1'
Floor___ Debris: No Visible/Fine Layer =]Ne to 1'
Comments
•1Date: , Inspection Team: Name: _ _t-
ENTE RED Name: Agency:
NYC-WTC 000129182
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000129182Source: NYC Law Department, mirrored locally