WTC building inspection form, residential/commercial

NYC 9/11 Public Portal Document

WTC Visual Survey Form I '? 01 Premise Address:

Block: / ResiderWalD Commercial 0 I Name of Building: PS S

Lot: Mix Use Other # of Stories:L I AKA's: fl `' -, r ~ . Building Owner/Management: Telephone Number: ( ) Name: Lf tr``-A% I e +• 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 EJ Yes

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Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'A to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'A,to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer E] '/2 to 1" ❑ > 1" Facade Description: - n

Roof st

Debris: ❑ No Visible /Fine ayer 0'/2 to 1"l = ❑ > 1" / 1 Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'A2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'A to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1"

Date: _/x_/2002 Inspection Team: Name: ~~. Agency: Name: Agency:

NYC-WTC 000092938