102 JOHN STREET 1001128, 69/50

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1 ~.`~-•~.,° 'remise Address:

Mock: Residential :. Commercial Name of Building: Lot: . Mix:Use' .Other❑ .# of Stories: ç. AKA's: Building Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact: Name: Telephone Number. Building Owner Managyient Activities Interior Survey Performed ❑ Yes j 1 o Exterior Survey Performed ❑ Yes r51Jo General Clean Up ❑ Yes Q'No Locations: ACM Clean Up ❑ Yes l Locations: Air Monitoring ❑ Yes No Locations: Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A es ❑ No ,~N Visible/Fine Layer ❑'/ to 1" ❑ > 1" South ❑ NJA ❑ Yes 2'No ❑ No Visible/Fine Layer ❑'/2 to 1" []>I" East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Description:

Debris: o Visible /Fine Layer [31/2 to 1" [3 > 1" Descriptio . " o 1 i

Setbacks N/A ❑ I / Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" [3 > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [3 > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" [3 >1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [3 >1. Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Comments ~OK6 C__ - z~`~ _100 . low (0 ' I ' 10 v.~ cLD\- ti.,o k- ,2C-L)s -t Date: / (7 /20Q Ins on by: Name: Agency: __ Name: Agency:

NYC-WTC 000093499