WTC Visual Survey Form
Premise Address:
Block: Residentia1 Commercial jJ Name of Building:
Lot: Mix UseD Other
# 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 DYes[]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 p Yes
Visual Inspection Results:
Facade:
North /A
Inspected
❑ Yes [Q No
Debris
O No Visible/Fine Layer to 1' fl >1 "
South
Ea
West
EJ N/A
4 /A
/A 9YesDNo
Yes No
o o Visible/Fine Layer
No Visible/Fine Layer
No Visible/Fine Layer
R0%to1"
%to11
h to 1"
>10
>10
D>1"
Facade Description:
Setbacks N/AL]
Floor____ Debris: No Visible/Fine Layer 934 to 1" >10
Floor____ Debris: No Visible/Fine Layer 34 to 1" >V
Floor____ No Visible/Fine Layer 36 to 1' >V
Floor__ Debris: No Visible/Fine Layer 36 to 1" >1
Floor____ Debris: No Visible/Fine Layer h to 1" >10
Comments
Date: S /12002 Inspection Team: Name: CA Z Agency:
Name: Agency:
ENTERED
NYC-WTC 000134105
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000134105Source: NYC Law Department, mirrored locally