80 JOHN STREET 1001115, 68/33

NYC 9/11 Public Portal Document

a

WTC Visual Survey Form BN1* i b O %11 S Premise Address:

Block: (o% -O 6 Residential 0 John Commercial j J S+re e +-

Name of Building: Lot: 33 Mix Use ❑ Other ❑ # of Stories: AKA's: -a eee 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 bris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'a to 1" O>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" O>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ %to 1" O>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to 1" O>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ % to 1" O>1" Description:

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

Comments

Date: //2002 Inspection by: Name: AP Agency: DEP Name: Agency:

NYC-WTC 000093144