WTC property information form, Oct 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form j Pr~misc Address: - ~~

Block: ', Residential U Commercial ❑ Name of Building: Lot: ", '~=- 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 Kesults: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>I - South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer -]'/2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ztol" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" 0>1" Facade Description: L' c L4 Roof st; Debris: ❑ No Visible /Fine 'Ls ❑ % to 1" .i :Ire► [1> 1 " '/ :L-4. Description: N~ Ik - - --

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 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 ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Date: __/= /2002 Inspection Team: Name: --~ L, Agency: Name: Agency:

NYC-WTC 000094371