41 JOHN STREET 1075701, 78/7502

NYC 9/11 Public Portal Document

WTC Visual Survey Form I O -7 c -7 O I Preniis~-Ad dress: c (— J

Block: —] Residen ' I Commercial Name of Building: Lot: s Os 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 Kesuits: Facade: Inspected Debris North ❑ N/A []Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1" Y2 ❑ > 1" South - ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Description:

Roof pJst; Debris: ❑ No Visible /Fine r _ ❑'/2to1"1 '- ❑>1" 1 Description:

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

Date: 3 / — /2002 Inspection Team: Name: [_ Agency:

JO Name: Agency:

NYC-WTC 000092949