17 JOHN STREET 1001216 79/10

NYC 9/11 Public Portal Document

WTC Visual Siirvpv Fnrrn Prem$s Adress:

Block: I Residential 0 Commercial Nams of Building: Lot: I Mix Use 0 Other # of Stories: I AKA's: BuHding Owner/Management: Telephone Number ( ) Name: nV\e-.A ' • 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 fl , Visual Inspection Results: Facade: Inspected Debris North ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1' ❑> 1' South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1' 0>? East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ i4 to 1' 0'? West ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑34to 1' ❑> 1' Facade Description: /) ()

Roof

Debris: [ No Visible /Fine Layer . ❑ % to? 0>? Description:

Setbacks N/A1 Floor Debris: 0 No Visible/Fine Layer ❑ % to 1' Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1' Floor.____ Debris: ❑ No Visible/Fine Layer ❑ 34 to 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ i4 to V

Date: D I 2"f'/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000093507