WTC visual survey form, 122 Nassau Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 100 aSS 5+r,C e Block: g2„ Residential 0 Commercial p Name of Building: Lot: 2 Mix UseD Other 0 _.

# 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South Q N/A Q Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" West ❑N/A QYes❑No ❑ No Visible/Fine Layer ❑'/2 to 1" 0>1" Facade Description:

Roof

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

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑'h 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 0'/2 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: 1Q 12002 Inspection by: Name: CL Agency: Ut V Name: Agency:

NYC-WTC 000098720