WTC debris inspection form, 116 Nassau Street, June 2002

NYC 9/11 Public Portal Document io1go4Lj WTC Visual Survey Form Premise Address:

Block: 2 11( N uss &U. ResidentialD Commercial 0 S 4re.k Name of Building: Lot: 2y Mix Use D Other # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: FAX: Address: On Site Con Name: Q Telephone Number. Building Owner Manag ment 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑ V to 1" > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'% to 1" > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" >10 West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" > 1" Facade Description:

Roof

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

Setbacks Floor Floor: M?-Jj, Debris: ❑ No Visible/Fine Layer ( / to 1" Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0 h 10 10 ❑ > 1"

Comments

Date: . 1i !2002 Inspection by: Name: Name: C. L Agency: Agency:

NYC-WTC 000098929