NYC 9/11 Public Portal Document
IN26317
WTC Visual Survey Form
Block: Ke51Qe11Ud1 vv" ' L-J
Lot: ©I Mix Use Othe r
,b 1 ;4;
# of Stori s: AKA's: —
Building Owner/Management: Telep one umber. ( ) 5 7 ~"
ScRa.+ cC . C~-i2-P FAX: SS - 3 2.9
Name: 7t ,c,iZ fi t;-M. fctD17
Address: 2Sfv fJ oiZ C;H Lk. KI fi c ¼1
On Site Contact: Telephone Number: ( )
Name: "
Interior Survey Performed ❑ Yes 0 No
Exterior Survey Performed ❑ Yes j No
General Clean Up 1 Yes ❑ No Locations: ,t+5 i f f,-7
ACM Clean Up ❑ Yes © No Locations:
Air Monitoring ❑ Yes © No Locations:
Codes of All Reports and Data Requested [] Yes
Visual Inspection Kesurzs:
Facade:
Inspected Debris
❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1"
North ❑ N/A ❑ Yes ❑ No
❑ Yes ❑ No ❑ No Visible/Fine Layer [J% to 1" ❑ > 1"
South ❑ N/A ❑ > 1"
East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"
❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1"
West ❑ N/A ❑ Yes [] No
Facade Description:
Roof
❑'/ to 1" ❑ > 1"
Debris: [1 No Visible /Fine Layer -'-
Description: Sl
Setbacks N/A ❑ ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑% to 1"
Debris: 0 No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor:
Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"
Floor.
Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1"
Floor
Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1"
Floor:
Comments
r%yenay.
Date: 0(__/.Ljç,J2002 Inspection Team: Name: /! t-
Name: ____________________Agency:
NYC-WTC 000134664
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