WTC debris inspection form

NYC 9/11 Public Portal Document

d WTC Visual Survey Form Premise Address:

Block: Residential Commercial Name of Building: Lot: 1501 Mix Use JjOther # of Stories: 5 AKA's: Building Owner/Management: Telephone Number: ( ) Narne: 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 0 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" South ❑ N/A © Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Debris: Q No Visible /Fine ayer ❑ Y to 1" •? -~ ''~ ❑ > 1" '1 "'' Description: I n(, C--(- M n -3-i aivJ -i

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1"

Comments

Date: /? /2002 Inspection Team: Name: PL Agency: Name: Agency:

NYC-WTC 000100170