Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document

WTC Visual Survey Form /o Sao L5 Pr en Address: 5 ci

Block: 1 Residential 0 tommercial Name of Building: Lot Mix Use 0 Other # of Stories: AKA's: 2'k& rso., Building Owner/Ma agement Telephone Number. ( ) Name: V - jc 1 RQ Q -L. FAX: Address: On Site Contact: Name: i Telephone Number Building Owner Management Actly es Interior Survey Performed ❑ Yes J 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 ❑34to 1" 0>'? South ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer 034t01' ❑ > 1" East ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer D 34 to 1' 0>1' West ❑ N/A ❑ Yes Q No ❑ No Visible/Fine Layer ❑ 4 to l' 0>1' Facade Description: n n

Roof

Debris: QNo Visible /Fine Layer ❑ % to 1' ❑ > 1' Description:

Setbacks N/A Z. Floor.____ Debris: U No Visible/Fine Layer U 'h to V ❑ 1' Floor____ Debris: ❑ No Visible/Fine Layer ❑ % to? a

1' >

Floor Debris: 0 No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor Floor____ Debris: ❑ No Visible/Fine Layer ❑'h to V Debris: ❑ No Visible/Fine Layer 934 to V H ❑ > 1' > 1'

Comments

Date: I2OQ Inspection Team: Name: Agency: -T B c/

Name: Agency:

NYC-WTC 000101808