NYC 9/11 Public Portal Document
WTC Visual Survey Form
Premise Address:
Block: '
ds
Residential Commercial f J Name of Building:
Lot: Mix Use Other
# of Stories: AKA's:
Building Owner/Management: Telephone Number: ( )
Name: —r z FAX:
Address: 1
On Site Contact:
Name: • Telephone Number:
Building Owner ManagementActivities
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 Re uested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to 1" 0>1"
South J N/A j Yes ❑ No O'No Visible/Fine Layer 0'% to 1" 0>1"
East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%toV ®>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Mato 1" 0>1"
Facade Description:
Roof
Debris: No Visible ❑'/ to 1" ❑ > 1"
Description:
Setbacks N/A'
Floor. I Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" [1> 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Comments
Date: /2 /2002 Inspection Team: Name: I~n-rM_ i)d ,_ Agency:
E T Name: Agency:
REO
NYC-WTC 000130746
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NYC-WTC_000130746Source: NYC Law Department, mirrored locally