55 JOHN STREET BN # 1079064

NYC 9/11 Public Portal Document

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WTC Visual Survey Form I v-T q1Q cod Premise Address: 5 5 :Yoh n 5freef Block•'? Residential 0 Commercial Name of Building: Lot: 4 Mix Use ❑ Other ❑ # of Stories: AKA's: i 3 \'\Jillianl -12 re,e Building Owner/Management: Teleph ne 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No Jo Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No XNo Visible/Fine Layer ❑'/ to 1" 0>1" West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: )< No Visible /Fine Layer ❑ % to 1" 0>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 ❑ V to 1" ❑ > 1"

Comments

Date: • Inspection by: Name: AI Agency: Og Name: Agency:

NYC-WTC 000093280