WTC exterior inspection form with setbacks

NYC 9/11 Public Portal Document

Q M%AV.e-1 WTC Visual Survey Form (/ ) Premise Address: __23. i t--.- --- Block: Lot: Residential 0 Mix Use Commercial Othertj Name of Building: 0 # of Stories: AKA's: Building OwneNManagement: Telephone Number: ) Tf 4 Name: FAX: Address: On Site Contact: Name: " ' Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes 0 No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes 0 No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested p Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer ❑ / to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1" 0>1" East ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑ Ya to 1" 0>1" West ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑Yzto1" 0>1" Facade Description: 4( _

Roof P,,str Nirk Debris: ❑ No Visible /Fine yer ❑ Y to 1" ? =I'"'~ 0>1" Description: G7

Setbacks N/A EU Floor. Debris: 0 No Visible/Fine Layer 0 .4 to 1" 0>1" Floor. Debris: 0 No Visible/Fine Layer 0 % to 1" 0>1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %to 1" ❑> 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1'

Comments

Date: ', ! S. /2002 Inspection Team: Name: `--- Agency: Name: Agency:

NYC-WTC 000099607