Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document

WTC Visual Survey Form f aO?8 Premise teas: -_ if . •

Bloc : )- ]ResidentidioCommercialEl Name of Building: (p Aat Lot Mix Use Other # of Sto e . AKA's: • , Building Owner anage ent: Telephone Number: ( ) 3 Q ZS Name: % Address: 2 FAX• 1. On Site Con ct: 3; 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 p Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1" E]>1' South 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ A to 1" 0>10 West ❑ N/A ❑ Yes ❑~ o ❑ No Vsible/Fine Layer ❑ Ya to 1" 0>10 Facade Description: Al

Roof

Debris: , 1c Visible /Fine Layer -❑ % to 1 " ❑ > 1" Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>10 Floor: Debris: ❑ No Visible/Fine Layer 0 Va to 1' ❑ > 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ A to 1" [] > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'A to 1' ❑ > 1"

Comments

Date: Inspection Team: Name: Agency: Name: Agency: ~! TA RE

NYC-WTC 000101788