WTC roof and facade inspection form

NYC 9/11 Public Portal Document

WTC Visual Survey Form irenise Address:

Block: :, 3 Residential fl Commercial Name of Building: Lot: 1 Mix Use 0 Other # of Stories: 'I AKA's: Building ner/Management: Teleptone Number: Name: ,FAX: Address: On Site Contact: 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 0 Yes

Visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Mato 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer %to t" ❑> 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" 0>1" Facade Description:

Roof t*3W Debris: ❑ No Visible /Fine layer _ ® Y to 1" Description: Itit ciC-t Cz-i> k~M c 2 1

Setbacks N/A In Floor. Debris: 0 No Visible/Fine Layer ❑ V: to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer 0 Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer 0 % to 1" ❑ > 1" Comments t; 'J ,,it 4't -1

Date: ' / 7 /2002 inspection Team: Name: A-. Agency: Name: r: ift c r L.K Agency: y{ . NYC-WTC 000099600