WTC building inspection form, 112 Liberty Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: --' r ~~~~

Block: ~'~ Residental El Commercial El I Name of Building: Lot: jO Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Management Te4 ph ne Number: ( ) Name: FAX: ( ) Address: On Site Contact: Name: " Telephone Number: ( ) Building Owner Management Activities n 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 ❑ Y2 to 1" 1" South ,RN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1" Y2 ❑ > 1" East ®'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West [N/A ❑ Yes El No ❑ No Visible/Fine Layer ❑ Yz to 1" ❑ > 1" Facade Descrio ion:

Roof

Debris: ❑ No Visible /Fine Layer ❑ Y2 to 1" > 1" Description: t I 1 Q.

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1"

Comments

Date Inspection Team: Name: u 11 ' Agency: Name: Agency:

NYC-WTC 000100571