Fiber Control Inc Revised Invoice for DEP Services, Sept 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential J Commercial Name of Building: Lot: 15O 1 Mix Use j Other # of Stories: 5 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 0 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested j j Yes

visual inspection KcsUltS: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No F] No Visible/Fine Layer ❑'/2 to 1" D>1" South ❑ N/A Q Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑> 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2tol" 0>1" West ❑N/A ❑Yes[]No ❑ No Visible/Fine Layer ❑%to 1" 0>1" Facade Description: 1._. t✓w"tr"4 e:h t ,-c' 0 rc

Roof ~~st _A.A 1 0 1" •j Debris: No Visible /Fine 1..ayer 0 % to 1" •1 > Description: I nr,, p it, ii J1e

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer D4 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 3h to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer 0 h to 1" ❑ > 1"

Comments ~pp

Date: ( ?_12002 Inspection Team: Name: PL Agency: Name: _Agency:

NYC-WTC 000100148