WTC debris inspection form, 9 Jay Street

NYC 9/11 Public Portal Document Y t. OIi 5Cff<YWy F6Rt1

9 - /07-z 2 / V serrise Address:

:!Block: j b Residential &mmercial Name of Building: Lot a Mix Use Other of Stories: AKA's: S1J4 P c e -` -E(. Building Owner/Management ei phone Number. ( ) Name: FAX: Address: On Site Contact Name: ' ' '' Telephone Number Building Owner Management Activities interior Survey Performed Exterior Survey Performed General Clean Up Yes No Yes No Yes No Locations: L] ACM Clean Up Yes No Locations: Air Monitoring L) DNo Locations: Yes Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected . Debris North NIA No No Visible/Fine Layer % to? >1' South NIA No isible/Fine Layer % to? >1' East N/A No isible/Fine Layer %to 1' > 1' West N/A #sj - No JJ No Visible/Fine Layer % to 1' >1' Facade Description:

Roof r

Debris: No Visible /Fine Layer t] 3 to 1' Description:P\

Setbacks WAD Floor__ . Debris: No Visible/Fine Layer 'A to 1' 'l Floor.___ Debris: No Visible/Fine Layer 36 to1' > 1' Floor__ Debris: No Visible/Fine Layer 36 to 1' > 1' floor:_,_ Debris: No Visible/Fine Layer %to? > 1' Floor___ Debris: No Visible/Fine Layer Y to1' > 1' Comments

Date: _S : 12002 lnspec ion Team: Name: Agency. dame: Agency: NTER.

NYC-WTC 000092811