112 JOHN STREET BI. 69Lot. 54/1001131

NYC 9/11 Public Portal Document

1' WTC Visual Survey Form 100113 1 Premise Address: 1/2- Toh" She Block: Residential D Commercial Q Name of Building: Lot: 51.1 Mix Use ❑ Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( .zo/ ) 767_70 Name: ç /Y! on FAX: ( ) Address: On Site Contact: Name: ' o cpk. 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 inspecuun rwsuuLs Facade: Inspected Debris North ❑ N/A Wes ❑ No No Visible/Fine Layer [:]%2 to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2to 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 E]%2 to 1" 0>1" Facade Description:

Roof

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

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

Comments /319S. d,,v r r,.of Cwzi"Ie- . fiift Gi/v6m/ i" r w. -.v7 @ 2-A-4 -''rt.

Date: 2 /1/2002 Inspection Team: Name: RAM~~__ Agency: .D'. 4 Name: Agency:

NYC-WTC 000093298