WTC Site Record ID 000093293, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: IrL- Block: Residential Commercial Name of Building: Lot: Mix Use J Other JJ #f Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: S FAX: Address: On Site Contact: b 4. Name: - ' . . . X& u ~~ rc- V 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: Ins ected Debris North ❑ N/A es ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ONo Visible/Fine Layer ❑'/ to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: [ Visible /Fine Layer E)'/ to 1" 0>1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: / / ' /2002 Inspection Team: Name: Agency: Name: Agency: ENTERED

NYC-WTC 000093294