102 JOHN STREET 1001128, 69/50

NYC 9/11 Public Portal Document

(00(12 C Visual Survey Form . Premise 0dre (O 0 I%v\ Block: Cd d Residential Commercial j Name of Building: Lot: 50 Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: Name: Telephone Number. (' ) Building Owner 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 Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z

to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑•No ❑ No Visible/Fine Layer ❑'/2 to 1" [1 >1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑'/2 to 1" ❑ > 1" Description:

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

Comments

Date: / /2002 Inspection by: Name: Agency: Name: Agency:

NYC-WTC 000093500