67 MURRAY ST 1001419, 132/2

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residentiatfl mmercial El Name of Building: Lot: Mix Use 1 Other # 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 ❑ 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 ❑ % to 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ to 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" Facade Description:

Roof u ❑> 1" .I Debris: Visible /Fine , ayer 1".I :iYl "- El 1/2 to Description:

Setbacks N/A'" Floor: Debris: ❑ No Visible/Fine Layer ❑'% to 1" Floor: Debris: ❑ No ViSible/Fine Layer 0 Y to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1"

Comments

3 Date: /2002 /x Inspection Team: Name: -_____

Agency: Name: Agency: ENTERED

NYC-WTC 000100506