WTC building inspection checklist, asbestos and debris

NYC 9/11 Public Portal Document

WTC Visual Survey Form /D 79/3 Premise Address:

Block: 77 Residential 0 Commerci Name of Building: Lot: Mix UseD Other . # of Stories: AKA's: Building Own r artageme t: Telephone Number: ( ) Name: 5 q \P\o~-L e v w~ FAX: Address: On Site Contact: -1 Name: Telephone Number: 242 Z 2' >c ) v Building Owner Management jctivlties Interior Survey Performed j Yes 0 No Exterior Survey Perfo ed [2'Yes D No General Clean Up es ❑ No Locations: ACM Clean Up ❑ Yes.No Locations: Air Monitoring D Yes D No Locations: Copies of All Reports and Data Requested 9 Yes

Visual Inspection Results: Facade: Ins ected Debris North 0 N/A Yes 0 No 0 No Visible/Fine Layer %: to 1" 9> 1" South 0 N/A i es 0 No ❑ No Visible/Fine Layer % to 1" ❑ > 1" East 0 N/A Yes 0 No 0 No Visible/Fine Layer a to 1" 9> 1" West ❑ N/A es ❑ No ❑ No Visible/Fine Layer : to 1" ❑ > 1" Facade Description:

Roof

Debris: No Visible /Fine Layer .D'/ to 1" Description:

Setbacks N/A ❑ Floor. Debris: 0 No Visible/Fine Layer 0'/a to 1" 0> 1" Floor. Debris: D No Visible/Fine Layer ❑'/a to 1" ❑ >V Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ Ya to 1" ❑ > 1" Floor: Debris: D No Visible/Fine Layer ❑ .4 to V ❑ > 1"

Comments

Date: / Z'_12002 Inspection Team: Name: Agency: Name: Agency: E 49°(rzEFR NYC-WTC 000093094