Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document

n WIC Visual Survey Form Premise ress: A n Block: f t I Residenti t ri Commercial Q Name of Building: r~ G Lot: .. Mix Use Other # of Sto es. AKA's: '-r/3I 5 in&oj" 1/ Building Owner anage ent: Telephone Number ( ) 3• ct Name: V FAX: Address: On Site• Contilt: 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 0 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes[] No o No Visible/Fine Layer ❑%to 1" 0> 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to l 0>? East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer F]% to l" 0>? West ❑ N/A [] Yes QNo ❑ No Visible/Fine Layer [:]'/: to t" ❑> V Facade Description:

Roof

Debris: fio Visible /Fine Layer •0 14 to? 9> 1 ' Description:

Setbacks N/A(] Floor. Debns: UNo ViStble/Fme Layer ❑'h to r U> 1" Floor Debris: ❑ No Visible/Fine Layer ❑ h to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor Debris: ❑ No Visible/Fine Layer 014 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ 14 to V ❑ > 1'

Comments

Date: //2002 Inspection Team: Name: Agency: N , Name: Agency:

NYC-WTC 000101798