WTC mixed-use building inspection form

NYC 9/11 Public Portal Document •v ii.. v/ua11 urVBy 1rW1f11 `Premise Address: $- iA

Block: ResidentialO Co Name of Sul ng: Lot Mix UseD Other N Y' 0 £L S #~ of Stories: AKA's: Building OwnerlManagement: Telephone Number ( ) Name: - FAX: Address: - On Site Contact Name: ' ' '' Telephone Number: Building Owner Management Activities Interior Survey Petfoted DYes No Exterior Survey General Clean Up Performed Yes No 8 Yes No Locations: :, ;, , ,.•. .

ACM Clean Up Yes No Locations: Air Monitoring Yes No Locations: Copies of All Reports and Data Requested fJ Yes

Visual inspection Results: Facade: Inspected Debris North NIA - Yes No No Visible/Fine 34 to 1' > 1' South N/A Yes No No Visible/Fine Layer 34 to 1' > 1' East N/A Yes No No Visible/Fine Layer 54 to 1' > 1' N/A Yes No No Visible/Fine Layer LayerH%tol" N*l* West Facade Description:

Roof Debris: _]No Visible /Fine Layet D Y to1' Description:

Setbacks N/AD Floor,__,. Debris: No Visible/Fine Layer 34 to1' >1' Floor.__ Debris: No Visible/Fine Layer 34 to1' > 1' Floor.___ Debris: No Visible/Fine Layer 54 to 1' > 1' Floor:_ Debris: No Visible/Fine Layer 4 to1' > 1' Floor_ Debris: No Visible/Fine Layer 54 to1' >1' Comments

r Date: / 12002 Inspection Team: Name• Agency: name: Agency:

NYC-WTC 000099614