DEP request for environmental data, March 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1066 L/3 -P?emise Address: I, Block: r$0 Residential Mix UseD Commercial Other . Name of Building: Lot: !O -t , r

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# of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: FAX: Address: J On Site Contact: Name:' Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes No Exterior Survey Performed D Yes No General Clean Up Q Yes Q No Locations: ACM Clean Up 0 Yes 0 No Locations: Air Monitoring Q Yes 0 No Locations: Copies of All Reports and Data Requested p Yes

Visual Inspection Results: Facade: Inspected • bris North NIA EYesE3 No No Vsible/Fine Layer 34 to 1' 0>1' South 0] N/A TJ Yes QNo No Visible/Fine Layer % to 1' 0>1' East ❑N/A ❑ Yes QNo No Visible/Fine Layer % to 1' 0>1' West ❑ N/A D YesQNo No Visible/Fine Layer ato 1' 0>1' Facade Description: {

t Root S

Debris: No Visible /Fine Layer ._] 6 to 1' 0>1' Description:

Setbacks N/A0 Floor Debris:D No Visible/Fine Layer % to 1' 03, 18 Floor Debris: Q No Visible/Fine Layer % to 1' > 1' Floor Debris: Q No Visible/Fine Layer % to 1' > 1' Floor. Debris: [] No Visible/Fine Layer y4 to 1' > 1' Floor Debris:[] No Visible/Fine Layer % to 1' > 1'

Comments

Date: -' II ( 12002 Inspection Team: Name: Agency: Name: Agency: ENTERE6

NYC-WTC 000093564