112 JOHN STREET BI. 69Lot. 54/1001131

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1001131 Premise Address: 1/2- aohn SJreO-t Block: Residential I I Commercial ❑ Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management: Telephone Number: (za/) 767-702' Name: ç a.-d /-1 o7 n FAX: ( ) Address: On Site Contact: Name: - v Telephone Number: ( ) Building Owne 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 •nspecuvn esuit ; Facade: Inspected Debris North ❑ N/A [Yes ❑ No f No Visible/Fine Layer ❑ % to 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1"

East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Li 1/2 to 1"

Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer CffY2to1" 0>1" Description:

Setbacks N/A ' Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments 2.~/ /31 c ) Cc t/tu ( 2 . ZNft c /i J •1 ?NA -?v r ~~ f?

Dat: 2- / /6 /2002 Inspection Team: Name: Agency: -D)P. Name: Agency:

NYC-WTC 000093295