WTC exterior inspection form with setbacks

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Com rcial Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: Telephone Number: Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed 9 Yes ❑ No General Clean Up ❑ Yes 0 No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring O Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual inspection Results: Facade: Inspected Debris North N/A R~.esQNo ❑ No Visible/Fine Layer ❑%to 1" 0>10* South IN /A s ❑ No ❑ No Visible/Fine Layer ii4 to 1" > 1" East ❑ N/A ❑YesQNo O No Visible/Fine Layer ❑ Ya to 1" >i West ❑ N/A ❑YesQNo ❑ No Visible/Fine Layer 0%to1" D>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer 16 to 1" '' -"• ' 9>10 Description:

Setbacks N/A[J Floor. Debris: D No Visible/Fine Layer ❑ 14 to 1" 0>1 0

Floor.____ Debris: 0 No Visible/Fine Layer ❑ 14 to 1" 0>10 Floor. Debris: Q No Visible/Fine Layer 0 y4 to 1" 0>1* Floor. Debris: Q No Visible/Fine Layer ❑ 14 to 1" 9 > 10 Floor. Debris: 0 No Visible/Fine Layer 014 to 1" 9>1 0

Comments

Date: t> /x_12002 Inspection Team: Name: Agency: Name: Agency: iENTERE3

NYC-WTC 000099608