WTC Visual Survey Form
Premise Address:
dential
LJ-.
Block: Res 0 Comme cial J Name of B ing:
Lot: Mix Use Othe `"
# of tories• t J 're,ucLSL
Building O • !Management• Teleph ne Number: ( )
Name: 6 ~'~ 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 Yes
Visual Inspection Results:
Facade:
Inspected Debris
North 0 N/A 1J\'es ❑ No ❑ No Visible/Fine Layer ❑'/to1" 1"
South /A 0 Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" D>1"
East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑/ztol" 0>1"
West /Pna~- ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to l" &i"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1"
Description: I ft
Setbacks N/A ❑
Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ %s to 1" ❑ > 1"
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.