WTC visual inspection form with debris description

NYC 9/11 Public Portal Document

WTC Visual Survey Form L 0O l oq'-/ Premise Address:

Block: (, j Residential 0 Commercial D Name of Building: Lot: Mix Use J 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 ❑ 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 Requested D Yes

Visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer D'/tor 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0Yto1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 034101" 0>1" Facade Description:

Roof Pjs Debris: ❑ No Visible /Fine yer ❑ Y2 to 1" •? `+'"' 0>1" '1 `i "" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1' ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments o Q-CC~.Ye

Date: 3/ 'x/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000099915