WTC visual survey form, 132 [name], 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form «'7' tb 1 Premise Address:

Block: esidential Commercial Name of Building: Lot: Mix Use Other # of Stories: AKA's: Building ner/M gement: Telephone Number: ( ) 77„ ( (~ Name: Address: On Site Contact: Name: Telephone Num ) • Building Owner Management Activities Interior Survey Performed ❑ Yes 0 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 es Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" [J> 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1"

Roof

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

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

Date: Inspection by: Name: Agency: Name: Agency:

NYC-WTC 000098765