12 JOHN STREET 1001103, 65/20

NYC 9/11 Public Portal Document

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Premise Address: WTC Visual Survey Form BN i 00 t t o3 ( J? Ic ! yq n S+ree-~ Block: (o Residential l Commercial 0 Name of Building: Lot: Zo Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: 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 J Yes

visual inspection K@suits: Facade: Inspected D bras North ❑ N/A ❑ Yes ❑ No [jNoVisibie/FineLayer ❑'%2 to 1" 0>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0> 1" Facade Description:

Roof

Debris: ' No Visible /Fine Layer ❑ %2 to 1" 0>1" Description:

Setbacks N/A Floor Debris: No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: o Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: DTto Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor. Debris: ❑ l Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments

Date: / I /2002 Inspection by: Name: AP Agency: DEP Name: Agency:

NYC-WTC 000094160