NYC 9111 Public Portal Document
a ik WTC Visual Survey Form
Premise Address:
1 *y
&
, ẁ`e
!!~ y
Block: Residential j Commercial Q Name of Building:
Lot: Mix Usegi Other
# of Stories: 4 AKA's:
Building Owner/Management Telephone Number. ( )
Name: FAX:
Address: 7-\
On Site Contact:
Name: ' " - Telephone Number.
Building Owner Management Activities
Interior Survey Performed 0 Yes Q No
Exterior Survey Performed 0 Yes j:] No
General Clean Up Yes Q No Locations:
ACM Clean Up Yes Q No Locations:
Air Monitoring 0 Yes Q No Locations:
Copies of All Reports and Data Requested Yes
Visual Inspection Results:
Facade:
Inspected Debris
North N/A Q Yes Q No [] No Visible/Fine Layer Q%to 1" 0>1"
South N/A Q Yes Q No ❑ No Visible/Fine Layer '~to 1" 0>1"
East D N/A Yes ❑ No No Visible/Finc Leyer Q h to 1'" 0>1"
West L] N/A Yes Q No No Visible/Fine-layer 03410 1" 0>1"
Facade Description:
Roof
Debris: PoVisiblemaxw Q % to 1" 0>1"
Description:
Setbacks N/A(
Floor
Floor.
Debris: 0 No Visible/Fine Layer 04 to V
Debris: No Visible/Fine Layer Q Y to V
0>1"
0>1"
Floor. Debris: E] No Visible/Fine Layer 034101" 0>1"
Floor. Debris: D No Visible/Fine Layer ❑ % to 1" ❑ >1"
Floor Debris: Q No Visible/Fine Layer Q % to 1" L] >1"
Comments
Date: / _12002 Inspection Team: Name: i fir}~. , ' i Agency: i2P
ENTERED Name: Agency:
NYC-WTC 000133984
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000133984Source: NYC Law Department, mirrored locally