133 JOHN STREET Block: 75 Lot: 9 BIN: 1001165

NYC 9/11 Public Portal Document

y V y WTC Visual Survey Form Premsee Address: t Block: Residential 0 Commercial Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Mar,' ge en• Telephone Number. ( ) Name: 1~ { FAX: Address: On Site Contact Name: ' " Telephone Number. Building Owner Management Activities Interior Survey Performed D Yes ~,No Exterior Survey Performed ❑ Yes No General Clean Up ❑ Yes D No Locations: ACM Clean Up ❑ Yes D No Locations: Air Monitoring D Yes D No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A D Yes D No O No Visible/Fine Layer ❑ % to 1' 0>1' South ❑ N/A D Yes D No ❑ No Visible/Fine Layer ❑34to1' []>1' East ❑ N/A ❑ Yes D No ❑ No Visible/Fine Layer ❑%to 1' 0> 1' West ❑ N/A =J YesD No ❑ No Visible/Fine Layer D % to 1' D > 1' Facade Description: ci (1

Roof

Debris: o visible /Fine Layer D34to1' []>1' Description:

Setbacks WA~ Floor Debris: [] No Visible/Fine Layer D % to 1' [J>1' Floor Debris:D No Visible/Fine Layer [] % to 1' ❑ > 1' Floor. Debris: D No Visible/Fine Layer ❑ % 10 1. ❑ > 1' Floor Debris: 0 No Visible/Fine Layer ❑'4 to V [J> 1' Floor. Debris: D No Visible/Fine Layer 9 6 to 1' 9> 1' Comments

Date: l I R002 Inspection Team: Name: - Agency: Name: Agency:

ENTERED NYC-WTC 000093316