WTC interior and facade inspection form

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Lot 133 Residential J Mix Use Commercial Other aims of Building: I 0 # of Stories: AKA's: Building OwnerlManagement Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: • • Telephone Number: Building Owner Management Activities interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed 0 Yes ❑ No General Clean Up ❑ Yes 0 No Locations: ACM Clean Up 0 Yes ❑ No Locations: Air Monitoring O Yes ❑ No Locations: Copies of All Reports and Data Requested fl Yes

Visual Inspection Results: Facade: Inspected Debris North 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0'a to 1" ❑ > 1" South ❑ N/A j Yes No ❑ No Visible/Fine Layer % to 1" 0>1" East 0 N/A ❑ Yes No O No Visible/Fine Layer 8%tol" 1" West ❑N/A OYesQNo 0 No Visible/Fine Layer D % to 1" 9> 1" Facade Description: ef [fir,' A :/j ..-L fkJf r,u P 57.

Roof Asti Debris: 0 No Visible /Fine 1.ayer [n'/ t01" = ", 0>1' 1 Description: i rr ~t / n 3 1'

Setbacks N/A13 Floor.____ Debris: 0 No Visible/Fine Layer 0 3'I 10 1" 0> 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor.____ Debris: 0 No Visible/Fine Layer 0 V to 1" 9>1' Floor. Debris: 0 No Visible/Fine Layer 0 V4 10 1' 0>1' Floor. Debris: 0 No Visible/Fine Layer IJ 34101' Comments , (?'A 7 f;24. lL'ty C,)'Y Mtn`-t42+J-c4

Date: €'(i 27 002 inspection Team: Name: Name: Agency: NYC-WTC 000099594