WTC mixed-use building inspection form

NYC 9/11 Public Portal Document VW 1 V w iauu1 vui v y W-Wj is# remise Address: --I 5 Block: ResidentialU Co rcial Nam f Suiiding: Lot , Mix Use Other 9pL4.S p _ * of Stories: 3. AKA's: Building Owner/Management Telephone Number. ( Z) 6r 9 Name: - !I t Address: On Site Contact: Name: ' ' .. N~' Telephone Number. Building Owner Management Activities Interior Survey Performed Yes No y r. . r 0 0 , 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 RequestedDyes Visual insoection Results: Facade: Inspected Debris North fl NIA Ves Q No No Visible/Fine % to 1 1' South D N/A s No o Visible/Fine Layer )4 to? 1' East D N/A Yes No No Visible/Fine Layer % to 1' !' West N/A Yes No No Visible/Fine LayerH%tol"I* Layer 1' Facade Description:

Roof Debris: D No Visible 1Fine Layer to!' >!' Description: )41%

Setbacks WAD Floor.___, . Debris: No Visible/Fine Layer ) to 1 D> 1' Floor:_ Debris: No Visible/Fine Layer % to1' > 1' Floor:__ Debris: No Visible/Fine Layer 14 to1' > 1' Floor:._ Debris: No Visible/Fine Layer % to1' > 1' Floor„__ Debris: No Visible/Fine Layer 16 to1' > 1' Comments

Date:.,, 12002 InspectionTeam: Name:_' M Mama: Agency:

NYC-WTC 000099613