WTC building information and inspection form

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residentia1Q Commercial 0 Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: AKA's: . . . . . . . . . . . . .Pii. . . . . . . . . . . . . . Building Owner/Management Telephone Numbers Name: FAX r. _________

Address:Contact._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.j._._._._._._._._._._._._ PII On Site 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 Results: Facade: Inspected Debris North ❑ N/A Q'Yes ❑ No I4lo Visible/Fine Layer ❑'/to1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑v2to l" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer n'/ to 1" 0>1" West ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑/2to1" 0>1" Facade Description:

Debris: No Visible /Fine Layer ❑'/ to 1" ❑.1" Descrintinnr :rl -Ar k"r i`, tYl (^ l L3(\ C s P tl llll

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

Comments

Date: / '2 /2002 Inspection Team: Name: ôr rO v Agency: AR Name: ~v,v~ (Qt4jç Agency:

NYC-WTC 000099591