WTC Visual Survev Form 1n03,381
Premise Address: r--
Block: ' T Resi ential CommercialD Name of Building:
Lot: Mix UseD Other
# of Stories: AKA's:
Building Owne fManagen e n Telephone Number. ( )
Name: AX:
Address: yU., ' . )J i
On Site Contact:
Name: ' Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes Q No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up Q Yes ❑ No Locations:
ACM Clean Up [lYes 0 No Locations:
Air Monitoring ❑ Yes 0 No Locations:
Copies of All Reports and Data RequestedD Yes
Visual Inspection Results:
Facade:
Inspected Debris
North ❑ N/A ❑ YesQNo ❑ No Visible/Fine Layer ❑Y2to 1' 0>1'
South Q N/A Q Yes ❑ No ❑ No Visible/Fine Layer 01#4tol' 0>1-
East ❑ N/A ❑ YesQNo Q No Visible/Fine Layer 0% to 1' 0>1'
West ❑ N/A j] Yes No Q No Vi le/Fine Layer Q%2to1' 0>1'
Facade Description:
Roof
Debris: to Visible /Fine Layer .Q % to 1' 0>1'
Description:
Setbacks N/A!
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑>1'
Floor. Debris: ❑ No Visible/Fine Layer 0 % to 1' 0>1'
Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1' 0>1'
Floor Debris: ❑ No Visible/Fine Layer ❑ h to? ❑>1'
Floor. Debris: ❑ No Visible/Fine Layer ❑% to? 0>1'
Comments
Date: 5 i 12002 Inspection Team: Name: \_ Agency:
Name: Agency:
F,'
N
NYC-WTC 000130849
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NYC-WTC_000130849Source: NYC Law Department, mirrored locally