Building information form, 111 Nassau Street, 2002

NYC 9/11 Public Portal Document

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1001 P I P WTC Visual Survey Form Premise Address:

Block: 0 1% t\115AU S1 ResidentialEl Commercial J Name of Building: Lot: I Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site C ct: Name: Y I p4( Telephone Number: I ) p 1 Building Owner Management A tivities 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 ❑ No ❑ No Visible/Fine Layer ❑ % 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 ❑'/ to 1" 0>1" Facad escription: 'T'~ li"IQ 2.t ,G (D.< Lt tii.t

Roof

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

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

Comments

Date: ! Inspection by: Name: L. L Agency: Witr Name: Agency:

NYC-WTC-000099100