17 JOHN STREET 1001216 79/10

NYC 9/11 Public Portal Document

WTC Visual Stirvev Form PrnishAddress: o Block: Residential Commercial Name of Building: Lot Mix Use Other 0 of Stories: AKA's: Building Owner/Ma a ment Telephone Number ( ) Name: 'f \9c e A -Th I-~1- Co 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 Insoectlon Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El% to 1 0>1. South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1' ❑>1' East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El% to 1' D>1• West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El% to 1' D>1• Facade Description: A

Roof

Debris: Visible /Fine Layer ❑%to 1' 0>1 Description:

Setbacks N/AI" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>1. Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ 6 to V ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ 6 to 1' ❑ > 1' Floor Debris: 0 No Visible/Fine Layer ❑ % to 1' ❑ > 1' Comments Q Ij c.~- ~ Q (A,.Ji_f-

Date: =/ RQt?2 Inspection Team: Name: Agency. Name: Agency:

NYC-WTC 000093509