17 JOHN STREET Block: 79 Lot: 10 BIN: 1001216

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: rr o t N STQEE Block: Residential L1 Commercial Name of.Bulldinx . Lot Mix Use J Other ❑ # of Stories: - AKA's: Building Owner/Management Telephone Number (zit ) rob - 3030 Name: MEUZo Locr MAM.N-- MINT FAX: 2l2 -ro - 2s2s Address: t T JoU N s -M r WCW -to¢ N 10038 On Site Contact Name: ' ' JA c.- 13 ►~+ Telephone Number z tz zos -3o3o Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ® Yes ❑ No Locations: FA co 4 QtOF SuP-r-A ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual inspection KeSUILS: Facade: Inspected Debris North ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑ % to l' 0>1' South ❑ N/A g] Yes ❑ No No Visible/Fine Layer ❑ %to 1' 0>1' East ❑ N/A Yes ❑ No ® No Visible/Fine Layer ❑htol' 0>I - West ❑ N/A ® Yes ❑ No ® No Visible/Fine Layer 0% to 1' 0>1 - Facade Description:

Roof

Debris: 0 No Visible /Fine Layer 13 to 1' 0>1' Description: t 'i3 W S l-Oe tr U j3D 2- EA TtA

Setbacks NIA Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ 3i to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ 4 to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ 34 to 1' ❑ > 1'

Comments

TrF

Date: o8 / 12 /2002 Inspection Team: Name: DA / A 020 Agency: 1' Name: Agency:

NYC-WTC 000094332