WTC debris visual inspection form, 5-story building

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercial 0 Name of Building: Lot: Mix Use D Other # of Stories: 5 AKA's: Building Owner/Management: Telephone Number: () 12..) 3S, ? 3z -4 Z Name: ' ' " i2 — 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 Yes

visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑y:to1" ❑>1" South ❑ N/A J Yes ❑ No ❑ No Visible/Fine Layer ❑y2to1" E1>1' East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/to1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2 to 1" ❑> 1" Facade Description: ti- i 'A I)

Roof

Debris: ❑ No Visible /Fine 04to1"•1=' ❑>1" •1 Description: ? c'4yt i:;- Z fibs - ; P,.124- i

Setbacks N/A Q Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1" ❑ > 1"

Comments

Date: C6l/ .)Z/2002 Inspection Team: Name: Agency: Name: my

Ff .-tx Agency:

NYC-WTC 000100415