WTC visual survey form, 122 Nassau Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1 1 oo,z 7(o Premise Address: I 3 8+re e Block: 2, Residential 0 Commercial p Name of Building: Lot: 25 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 Kesuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" West ❑ N/A ❑ Yes O No ❑ No Visible/Fine Layer ❑%2to 1" 0>1" Facade Description:

Roof

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

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

Comments

Date: t / /2002 Inspection by: Name: CL Agency: D6 P Name: Agency:

NYC-WTC 000098722