NYC 9/11 Public Portal Document
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WTC Visual Survey Form.
Premise Address:
3 03
Residential Commercial • Name of Building:
Block:
Mix Use fl Other
Lot: Lo
# 0f StorI s• • AKA's: 7?-I/--i
4V 01)cii 1-./ i,',, Wia
) S7 -- 6 o-~
Owner/Management: Telephone Number (
Building
- M-- f5C +~+,~C S Co-R-P FAX: ( ) S S- 7 - 3Z
Name: 'v yiZ eC
Address: c4 - t*t-: r ter fo
fi} O
On Site Contact:
Telephone Number: ( )
Name: -
Building Owner Management Activities
Interior Survey Performed []Yes 0 No
Exterior Survey Performed ❑ Yes I ] No
General Clean Up jJ Yes ❑ No Locations: i N+Sin -+- ts, f S t /)1
ACM Clean Up ❑ Yes ® No Locations:
Air Monitoring ❑ Yes l No Locations:
Copies of All Reports and Data Requested ❑ Yes
Visual Inspection Kesui~s:
Facade:
Inspected Debris
❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2to 1" ❑ > 1"
North ❑ N/A
❑ Yes ❑ No ❑ No Visible/Fine Layer 1/2to 1" ❑ > 1"
South ❑ N/A El
❑ > 1"
❑ No Visible/Fine Layer '/2 to 1"
East ❑ N/A ❑ Yes ❑ No ❑
❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"
West ❑ N/A ❑ Yes [] No
Facade Description:
Debris: Q No Visible /Fine Layer ❑ '/2 to 1" ❑ > 1"
C I% C &- "2- -a.- JL
Description:
Setbacks N/A ❑
Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1"
Floor:
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to I" ❑ > 1"
Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor:
Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"
Floor:
Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor:
Comments
Inspection Team: Name: Agency:
Date: (7( /__/2 002
Name: kfk21 L1 Agency:
t A z Ef
NYC-WTC 000134667
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