Block: JI Residential
bCommercial9
-r
Name of Building:
Lot i Mix UseD btherp
# 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 ❑ 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 D Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 0 N/A ❑ Yes 0 No 0 No Visible/Fine Layer ❑ 34 to 1' 9>1.
South ❑ N/A ❑Yes ❑ No ❑ No Vsible/Fine Layer ❑ 34 to 1' 0>1.
East ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer 034t01' 9"l'
West 0 N/A ❑Yes ❑ No~ ❑ No Visible/Fine Layer ❑ % to 1' 9>1'
Facade Description: ,' 9
Roof
Debris: No Visible /Fine Layer -E] % to 1' ❑ > 1'
Description:
Setbacks N/A`'(
Floor. Debris: ❑ No Visible/Fine Layer '4 to V 0>1.
Floor Debris: 0 No Visible/Fine Layer i4 to 1' 0>1'
Floor Debris: ❑ No Visible/Fine Layer 34 to 1' > 1'
Floor Debris: 0 No Visible/Fine Layer ❑ 4 to 1' > 1'
Floor Debris: ❑ No Visible/Fine Layer ❑ i4 to 1' >1°