WTC inspection form, 13 Jay Street, Sept 2002

NYC 9/11 Public Portal Document

(/ WTC Visual Survey Form (coo 2_0 2-5 Premise id dres :. )

Block: ig0 Residential Commercial 9 Name of Building: L-, ' . Lot [ Mix UseD Other # of Stories: AKA's: Building Owner/Management Telephone Number ( ) Name: A'4 -tau-s Q O C e-4 ` (a 2 . Cud (NG-S1eWN.FAX: Address: i J N - On Site Contact Name: ' ' Telephone Number: Building Owner Management Activities Interior Survey Performed Yes No Exterior Survey Performed Yes No I General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes No Locations: Air Monitoring D Yes ❑ No Locations: Copies of All Reports and Data Requested p Yes t. Visual Inspection Results: Facade: Inspected Debris North 9N!A ❑ Yes No O No Visible/Fine Layer 34 to 1 9'? South N/A es No o Visible/Fine Layer %tot' >1' East N/A Yes No No Visible/Fine Layer i4to1' >1' West N/A Yes No No Visible/Fine Layer %to ? w > 1a Facade Description:

Roof Debris: No Visible /Fine Layer .L]% to r 9>? Description

Setbacks NIAD Floor.___ . Debris: No Visible/Fine Layer 34 to 1' >1' Fbor: _ Debris: No Visible/Fine Layer 34 to-?- > 1' Floor.____ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor____ Debris: No Visible/Fine Layer Va to 1' > 1' Floor:___ Debris: No Visible/Fine Layer 34 to 1' > 1' Comments

Gate: 1 12002 Inspection Team: Name: _/{'7 Agency: E Name: Agency: N T

NYC-WTC 000094101