Laboratory fax transmission page, EMSL, Jan 2002

NYC 9/11 Public Portal Document

Promise Addres It 3 WTC Visual Survey Form FWP "",- Block: Residential 0 Commercial D Name of Building: Lot: 750 1 Mix Use J J Other '-/141(4 # 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 Q Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual inspection Kesults: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A © Yes ❑ No ❑ No Visible/Fine Layer 0 % 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 ❑ % to 1" 0>1" Facade Description:

Roof ~W s-1. Debris: © No Visible /Fine , yer _ Q'/: to 1" 9 -~'"' ❑ > 1" 1 Description: -cC--' H9a.vn

Setbacks N/A g] Floor. Debris: ❑ No Visible/Fine Layer ❑ a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1" Floor: Debris: Q No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: J No Visible/Fine Layer Q'/: to 1" D> 1" Floor. Debris: 0 No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"

Comments

Date: i/ .17 12002 Inspection Team: Name: ~c Agency: Name: [K Agency:

NYC-WTC 000097511