WTG Visual Survey Form C.LEAt4
Premise Address:
4o FuL1DN STe -r
Block: -is Residential jJ Commercial L J Name of Building:
Lot: a' Mix UseD Other
# of Stories: z AKA's:
Building Owner/Management 40 u --rte M u.e Telephone Number. (2 0z) 26' - 8 r
Name: m t~ W'r L c 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: ROOF s ces A*3D .og S0e~ess
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring ❑ Yes[] No Locations:
Copies of All Reports and Data Requested J Yes
Visual-inspection Results:
Facade:
inspected Debris
North ❑N/A ®Yes❑No ® No Visible/Fine Layer ❑Yto1" 0>1".
South ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1"
East ❑ NIA ® Yes ❑ No No Visible/Fine Layer ❑Vato 1" 0>1"
West ❑ N/A Yes ❑ No ® No Visible/Fine Layer 0Y2 to 1" 0>1"
Facade Description:
Roof
Debris: ® No Visible /Fine Layer ❑ % to 1" ' ' ❑ > 1"
Description: sQ w-m. E rz Is o1E~SGeJEU
Setbacks N/A ❑
Floor 2G' Debris: ® No Visible/Fine Layer ❑'/ to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: 0 No Visible/Fine Layer 0 %a to 1" 0>1"
Floor. Debris: 0 No Visible/Fine Layer 0 % to V 0>1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" 0>1"
Comments