116 JOHN STREET 1001126, 69/32

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 11 ZG s?nise Address: !/I -John ,Tram Bloc Residential 9 Commercial 0 Name of Building: Lot: Mix Use ❑ Other # of Stories: 3• AKA's: Building Owner!Management:1&,j '; fir- Kess Telephone Number: (2(x) 2.3 3 _%( Cjra FAX: Name. cw'~ 'sue m Address: On Site Contact: Name: G,~ . Telephone Number: ( Z/Z) 233--4f-2JI - Building Owner Management Activifies Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up [9Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring JYes ❑ No Locations: Va-,ws F Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A f'Yes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1" South ❑ N/A 'Yes ❑ No No Visible/Fine Layer ❑'/ to 1" ❑ > 1" East ❑ N/A E Yes ❑ No LII Visible/Fine Layer No ❑'/ to 1" ❑ > 1" West ❑ N/A gf Yes ❑ No No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" Facade Description:

Roof

Debris: [j] No Visible /Fine Layer ❑%to 1" 0>1" Description:

Setbacks N/A ❑ Floor. , Debris: No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: EJJ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 9 ½ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Yz to 1" ❑ > 1"

Comments

Date: 2- / Q:/2002 Inspection Team: Name: Agency: W_ _ Name: Agency:

NYC-WTC 000093300