Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document 1®0.2033 WTC Visual Survey Form -2 1 /0 3o~ 002 emise

Block: ress: 'i ResidentiiT1 CommercialD I Name of Building: -r Lot: Mix Use Other # of Sto es—. AKA's: • 3 7 S' , Building Owner anage ent+ Telephone Number ( ) a Name: V FAX: Address: On Site Con t Name: ' H '' Telephone Number. / iO63 '- /2

Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes 9 No Locations: ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring D Yes ❑ No Locations: Copies of All Reports and Data Requested I I Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'h to 1' [J>1' South ❑ N/A Yes No No Visible/Fine Layer ❑'/2 to 1' 0>1" East N/A H Yes [] No g No Visible/Fine Layer 914t01' 0>1" West O] N/A ❑ Yes ❑ o ❑ No Visible/Fine Layer ❑ Y2 to 1' ❑ > 1' Facade Description: n1) —1

Roof

Debris: 1Iio Visible /Fine Layer .914 to 1' 9>1" Description:

Setbacks N/A Floor___ Debris: ❑ No Visible/Fine Layer 14 to 1' 0>1" Floor Debris: No Visible/Fine Layer g % to 1' > 1' Floor Debris: E] No Visible/Fine Layer ❑ 4 to 1' > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ h to 1' ❑ >1" Floor Debris: ❑ No Visible/Fine Layer 14 to 1' ❑ >1"

Comments

Date: Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000101803 - - --