WTC Facade Inspection Form, 159 Maiden Lane, 2002

NYC 9/11 Public Portal Document r P.

WTC Visual Survey Form IO—?QQSd Premise Address:

Block: ResidentialD Co'mmercia Name of Building: Lot: 7 Mix Use Other # of Stories: AKA's: Building Own !Management: 3i1i Q r sb Telepho a 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 0 No Locations: ACM Clean Up 0 Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested J Yes Visual Inspection Results: Facade: Inspected Dpbris North ❑ N/A Yes ❑ No g.No Visible/Fine Layer ❑ 36 to 1 ❑ > 1" South 0 N/A LVJVs 0 No ❑ No Visible/Fine Layer ❑ 34 to 1' ❑ > 1' East ❑ N/A Yes 0 No - 10 Visible/Fine Layer ❑ % to 1' ❑ > 1" West ❑ N/A es 0 No Visible/Fine Layer ❑ 34 to 1" ❑ > 1' Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer 9%to1" 0>1' Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer 0 34 to 1' ❑>1" Floor Debris: 0 No Visible/Fine Layer ❑ 36 to 1' ❑ > 1' Floor. Debris: 0 No Visible/Fine Layer ❑ % to I' 0>1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>1' Floor: Debris: ❑ No Visible/Fine Layer ❑ r4 to 1" 9>1' Comments \-\ cc '-'

Date: Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000100066