WTC debris inspection form, 116 Nassau Street, June 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: 4 I1(D Nau.ss&uS4re.th Residential 0 Commercial Name of Building: Lot: ',$ Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Con , _._._._._._._._._._._._._._._..._._,.,.._._._._._._._._._._._._._. Name: Telephone NumbeF P11 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 O No ❑ No Visible/Fine Layer 0 Y 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" > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /z to 1" > 1" Facade Description:

Roof

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

Setbacks t'4/A j Floor: Floor: __41. Debris: ❑ No Visible/Fine Layer X4 to 1" Debris: ❑ No Visible/Fine Layer ❑'/ to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1"

Comments

Date: Inspection by: Name: C. L Agency: N Name: Agency:

NYC-WTC 000098944