WTC mixed-use building inspection form

NYC 9/11 Public Portal Document

WTC Visual Survey Form 'S4 M~l►nrs.._ Premise Address: (,3 Block: Residentia T Commercial Name of Building: Lot: Mix UseD Other # ofStories: f 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 ❑ Yes 8 No 4 ` General Clean Up ❑ Yes 0 No Locations: ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: In cted bris North ❑ N/A DYes ❑ No No isible/Fine Layer ❑ i4 to 1" 0 >V South ❑ N/A DYes ❑ No No Visible/Fine Layer ❑ 3h to V ❑> V East ❑ N/A DYes 0 No D No Visible/Fine Layer ❑ % to V ❑ > 1' West ❑ NIA ❑Yes ❑ No ❑ No Visible/Fine Layer j= y to l' 0:1- V Facade Description:

Roof Debris: j0 No Visible /Fine Layer .0 % to 1' []> 1' Description:

Setbacks N/A❑ Floor____ Debris: ❑ No Visible/Fine Layer 04 to V 0>1* Floor. Floor.____ Floor. Debris: 0 No Visible/Fine Layer 014 to 1' Debris: 0 No Visible/Fine Layer034101' Debris: 0 No Visible/Fine Layer 34101' 0 > 1' > 1' ❑ > 1' Floor. Debris: fl No Visible/Fine Laver 341o1' 1-1> 1" Comments

Date: x/_/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000099611