55 JOHN STREET BN # 1079064

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 5S JON A STR T Block: Residential 0 Commercial j Name of Building: Lot: y Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number. ( ) Name: FAX: Address: On Site Contact: Name: * ' B%~ {1ODEL 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 J Yes Visual'Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1". ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer South East West ❑ N/A ❑ N/A tj Yes ❑ No Yes ❑ No ❑ No Visible/Fine Layer ~ '/a%to 1" to 1" ❑ No Visible/Fine Layer 0%ato 1" 0>1" 0>1" 0>1" Facade Description:

Roof

Debris: 'No Visible /Fine Layer ❑'/ato1 - 0>1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 %a to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ 2 to 1" ❑ > 1" Comments

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Date: Oe / 30 /2002 Inspection Team: Name: 'DA / A-02-a Agency: Name: Agency: NTERE3

NYC-WTC 000093268