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

NYC 9/11 Public Portal Document

WTC Visual Survey Form Br 1 1001 ZI(io Premise Address: 17 _ 03 John S'+ree Block: ResidentialD Commercial J Name of Building: Lot: i ® 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 ❑ Yes

visual inspection Results: Facade: Inspected bris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A [] Yes ❑ No No Visible/Fine Layer ❑ Ya to 1" 0>1" Facade Description:

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

Setbacks N/A ❑ Floor. No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: LJNo Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: jJNo Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: INo Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris:lNo Visible/Fine Layer ❑ % to 1" Debris: ❑ > 1" Comments

Date: (P / ! /2002 Inspection by: Name: AP Agency: DE P Name: Agency:

NYC-WTC 000094337