12 JOHN STREET 1001103, 65/20

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 12 io 1J Block: Residential J Commercial p Name of,Bulldin.w." Lot Mix UseD Other 0 t-t . # 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ®Yes❑No ❑ No Visible/Fine Layer ®%to1' ❑>1' South ❑ N/A ®Yes❑No ❑ No Visible/Fine Layer 5§'h to 1 0>11 East ❑ N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ltol' 0>1' West 0 N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Ya to 1' 0>11 Facade Description: 4t AvY D -% S 1s s fr $I t4 S Arab o N THE 2p

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1' 9> 1' Description: ►.,o - o ~— o f -Tats S

Setbacks N/A ❑ Floor 3a-o Debris: ❑ No Visible/Fine Layer ® % to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>1. Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>1w Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>11

Comments

Dal: t3 I / 02 Inspection Team: Name: bQ I Ps20 Agency: Name: Agency:

NYC-WTC 000094191