WTC building inspection form, facade and structural assessment

NYC 9/11 Public Portal Document

WTC Visual Survey Form t'nTse Address:

Block: ResidentialLi Commercial 1 Name of Building: Lot: Mix Use 0 OtherD L& SI # of Stories: z AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: ' " Telephone Number: Building Owner Management Activities Interior Survey Performed 0 Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up 0 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ v to 1" ❑ > 1" South ❑ N/A Q Yes ❑ No ❑ No Visible/Fine Layer [D'/ to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description: t€ 4 1 C- t D t/i;2 l)ta- ----------- r-7^~~v✓t S~12 &t'

Roof D,~st Debris: ❑ No Visible /Finel.ayer Q %01" •? - '~ ❑ > 1" Description: i ru S1'ti 'iC-+1 t -1 ' 2 f rte rtC

Setbacks N/A E Floor. Debris: 0 No Visible/Fine Layer ❑'a to 1" 0> 1 "

Floor: Debris: 0 No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ i4 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 A to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Comments

Date: 6t I /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000099597