WTC Visual Survey Form 106111z
Premise Address:
5-0 FU L"TnN S7-i2Eir r
Block: Residential 0 Commercial J Name of Building:
Lot: 7 Q Mix Use J Other H-ousc
# of Stories: AKA's:
Building Owner/Management: j t, G Gh. Telephone Number: (2/Z..) (602- ®S/ 2-
Name: l k.Q. FAX:
Address:
On Site Contact:
Name: s-i2.y // ri ~e. Telephone Number: 2/2- / q -Z,6 7z
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes 0 No Locations:
ACM Clean Up ❑ Yes [ No Locations:
Air Monitoring ❑ Yes Q No Locations:
Copies of All Reports and Data Requested Yes
Visual inspection Results:
Facade:
Inspected Debris
North ❑ N/A CR Yes ❑ No O ❑Y2to l" 0>1"
South ®'N/A ❑ Yes Q No No Visible/Fine Layer ❑'Y2 to l" 0>1"
East N/A ❑ Yes Q No ❑ No Visible/Fine Layer 0'/to1" 0>1"
West j N/A Q Yes Q No ❑ No ViSible/Fine Layer ❑1/2 to 1" 0>1"
Facade Description:
Roof
Debris: /Fine Layer ❑'/ to 1" ❑ > 1"
Description:
Setbacks N/A 0
Floor: Debris: Q No Visible/Fine Layer ❑Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: Q No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No ViSible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: Q No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Comments
Date: z / /6 /2002 Inspection Team: Name: l? • R i s#oi,,r&✓ Agency: -: P
Name: Agency:
NYC-WTC 000129298
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000129298Source: NYC Law Department, mirrored locally
DEP inspection form for documenting facade condition assessment and potential asbestos-containing materials at building following World Trade Center disaster.
WTC debris inspection form documenting visual inspection results for facade condition, ACM assessment, and building characteristics for a 3-story structure.