WTC visual survey form for residential building, 2002

NYC 9/11 Public Portal Document WTC Visual Survey Form Premise Address: 65 N Ass Au S-M .T Block: Residential Commercial U Name of Building: Lot: -7 5oI Mix Use J Other # of Stories: AKA's: 28 -30 .1©N N s-r T Building Owner/Management 6 s 1~ASSAu OWuwzs Co Telephone Number: ( ) Name: % PAS MMT CcN-P. FAX: Address: On Site Contact Name: ' ('u i e o (Bu so1--r) 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 0 N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑%:to 1" 0>1" South ❑ N/A ® Yes ❑ No ® No Visible/Fine Layer ❑%to1" 0>1" East ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑Yatol_ 0>1" West ❑ N/A ® Yes ❑ No ® No Visible/Fine Layer ❑Mato 1" 0>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ 34 to 1" ' 0> 1" Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1' Floor: Debris: 0 No Visible/Fine Layer ❑ %a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: 0 No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"

Comments

Date: 0T =/2002 Inspection Team: Name: 'DA/A020 4 R R /Ao7 S Agency: 3' P Name: Agency:

NYC-WTC 000099917