Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document

WTC Visual Survev Form .1O , 0 O' 1 Premise A ress: Block: Residenti i Commercial Name of Building: Lot'. Mix Use Other ( $ -2(G # of Sto e . AKA's: • 3( WU&QpLJ a 7 fflA9rso r/3I aw1'/ Building Owner anage ent: Telephone Number ( ) Q Name: i/R.►~ FAX: Address: On Site Con ct: 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 J J Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 014t01" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 16 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 016t01" 0>1" West ❑ N/A D Yes 9Jio ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description: /1 O —1

Roof Debris: o Visible /Fine Layer .916 to 1" 0> 1" Description:

Setbacks N/A Floor Debris: ❑ No Visible/Fine Layer 014 to 1" 0>1" Floor Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑'h to 1" 9> 1" Floor Debris: ❑ No Visible/Fine Layer D4 to 1" ❑ > 1" Comments

Date: - 1 /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000101793