WTC inspection form, 19 Jay Street, Oct 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form I nn2r) Premise Address: - 3 c-i Block: I Lot 1 Residential Mix Use 0 Other Com rcial d Name of Building:

# of Stories: f AKA's: f. Building Owner anagement Telephone Number. ( ) - Name: T E D. (_._._._._._._._._._._._._._._..._._._..._ ._._.F ._._._._._._._._._._._._._..._._._._._. ______

Address:Contactc------------------------------------------------------------.-..-_._._._._.,._._._._._._._._._r._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.W._._._._._ P11 On Site

1 Name: ' ' ~' "`~ Telephone Number. Building Owner Management Activities Interior Survey Performed Yes No Exterior Survey Performed YesE) No General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes No Locations: Air Monitoring j] Yes j] No Locations: Copies of All Reports and Data Requested Yes

Visual Insoection Results: Facade: Inspected Debris %tolo 9>1'

H North N/A Yes No sible/Fine Layer South N/A es No isible/Fine Layer 34 to 1' 9>1' 4 East N/A Yes No F sible/Fine Layer hto1' >1' West N/A 9 Yes 0 No isible/Fine Layer 3% to 1' 9>1 - Facade Description:

t Roof

Debris: Visible /Fine Layer .9% to 1' j] > 1' Description:

Setbacks N/AD Floor:___ Debris: No Visible/Fine Layer Y: to 1' jj> 1' Floor:____ Debris: No Visible/Fine Layer 36 to1' >1' Floor.____ . Debris: No Visible/Fine Layer % to 1' > 1' Floor____ . Debris: No Visible/Fine Layer % to 1' >1' Floor Debris: No Visible/Fine Layer % to1' >1'

Comments

Dane: _I I I .(12002 Inspection Team: Name: IV T Name: Agency:___________

NYC-WTC 000094119