100 JOHN STREET BI 69Lot. 7502/1001127

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1 0O 112'7 Premise Address: /a Block: Residential El Commercial El Name of Building: Lot: 7l5p Mix Use ❑ Other ❑ #of Stories: AKA's: Building Owner/Management:JNiC•t6, N1~4. Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: S IP=,i -'nen& Name: IBC EV 1 p L -A , G— 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 EYes ❑ No Locations: _TL_L Copies of All Reports and Data Requested ❑ Yes

visual 1nspecuun Resuu ; Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2'to 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1"

East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ Y2 to 1" ❑ > 1" Description:

Setbacks Floor: N/A 0 Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer El 34 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"

Comments 2lix p er Ls

Date: 2 // /2002 Inspection Team: Name: ~6) '~~s~✓ Agency: JP- Name: Agency:

NYC-WTC 000093171