Fiber Control Inc Revised Invoice for DEP Services, Sept 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form premise Address: l3

Block: ResidentialEl Commercial JJ Name of Building: Lot: Mix Use9 Other q L4 7 501 # 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 0 Yes Q No Exterior Survey Performed ❑ Yes No General Clean Up ❑ Yes 0 No Locations: ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring [] Yes 0 No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ NIA ❑Yes 0 No 0 No Vsible/Fine Layer h to 1' 9>1' South- 9 N/A Yes 0 No 0 No Visible/Fine Layer % to 1" 0>1' East j N/A 9 Yes 0 No 9 No Visible/Fine Layer 9 % to 1" 0>1' West 9 N/A DYes 0 No 9 No Visible/Fine Layer 9 Ya to 1" ❑> V Facade Description:

Roof ~,►st Debris: Q No Visible /Fine yer 9 a to 1" 1 =~'"'~ 9> V I Description: 'i S ~c z <(- 3 7ti1t, P-4A —+y

Setbacks WA j) Floor. Debris: El No Visible/Fine Layer 9 % to 1' 9>1' Floor. Debris: 0 No Visible/Fine Layer h to 1" ❑ >1' Floor____ Debris: No Visible/Fine Layer Va to V [] >1' Floor. Debris: No Visible/Fine Layer Floor____ Debris: No Visible/Fine Layer i4 to 1" % to 1" 8 > 1' > 1' Comments

Date: OL/i_/2002 Inspection Team: Name: 1fit Agency: Name: __ !a,r~ c r; Agency: I

NYC-WTC 000100149