WTC building survey form, asbestos and facade inspection

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: E1 y l _ LI3 o- 4 Block: Residential El Commercial El 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 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 ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El to 1" 1/2 ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El to 1" 1/2 ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" Facade Description: o A cc€SS

Roof ~ > 1" .1 ; C.~ Debris: ❑ No Visible /Fine a er '/2 to 1" •I ❑ Description:

Setbacks N/A ❑ Floor: = Debris: ❑ No Visible/Fine Layer to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer El 1/a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments

Date: -/ 002 Inspection Team: Na)ri4: Agency: C - Name: Agency: ENTERE3

NYC-WTC 000092936