Asbestos Project Notification and Inspection Report, Dec 2002

NYC 9/11 Public Portal Document

L

WTC Visual Survey Form Premise Address:

Block: Residential □ Commercial □ Name of Building: Lot______ Mix Use □ Other □ # of Stories: AKA’s: Building Owner/Management: Telephone Number ( ) Name: FAX:( ) Address: On Site Contact: Name: Telephone Number: ( ) Building Owner lUlanagement 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 Resulte: Facade: Inspected Debris North N/A □ Yes □ No □ No Visible/Fine Layer □ Htor □> r South N/A □ Yes □ No □ No Visible/Fine Layer □ Htor □> r East N/A □ Yes □ No □ No Visible/Fine Layer □ 14 tor □> r West N/A □ Yes □ No □ No Visible/Fine Layer □ Htor □ >r Facade Description:

Roof

Debris: □ No Visible /Fine Layer □ 72 tor □ >1" Description:

Setbacks N/A □ Floor. Debris: □ No Visible/Fine Layer □ 14 to 1" □> r Floor: Debris: □ No Visible/Fine Layer □ 14 to 1" □ > 1” Floor: Debris: □ No Visible/Fine Layer □ % to 1 □ >r Floor: Debris: □ No Visible/Fine Layer 014 to 1” □ >1’ Floor: Debris: □ No Visible/Fine Layer □ 14 to 1” □ >1” Comments

Date: / /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC_000149453