WTG Visual Survey Form
Premise Address:
4o G-re -r'
FULION
Block: -is Residential JJ Commercial jJ Name of Building:
Lot: i Mix Use p Other
# of Stories: z AKA's:
Building Owner/Management 40 ,-u.-r e u.c Telephone Number ( . ) 269.-81-- I
Name: rAec MA"AGeM~ S r i.Lc. FAX:
Address:
On Site Contact:
Name: ' * Telephone Number.
Building Owner Management Activities
interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ® Yes ❑ No Locations: R00c svV.F s /moo
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
Debris: ® No Visible /Fine Layer ❑ h to 1" " " ❑ > 1"
Description: NCB w -rr. ?»812 IS 0BSEPVE >
Setbacks N/A ❑
Floor. - Debris: ® No Visible/Fine Layer 0 h to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer 0V to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to V 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1"
Floor Debris: ❑ No Visible/Fine Layer ❑% to 1" 0>1"
Comments
Date: [/«/2tO2 Inspection Team: Name: `D A / Ao2 o Agency: WC 'oEP
Name• Agency:
NYC-WTC 000129206
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000129206Source: NYC Law Department, mirrored locally