Law Department divider sheet for WTC worksite documents

NYC 9/11 Public Portal Document

WTC Visual Survey Form 10777395 Premise Address: 3 Block: Residential J Commercial Name of Building: N Lot: Mix Us Other j J # of Stories: AKA's: Building Owner Wage nt: Telephone Number: ( ) Name: V F Address: -- On Site Contact: 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 ❑'/zto 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑/2to1" 0>1" East ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑,No Visible/Fine Layer ❑'/to1" 0>1" Facade Description:

Roof u Debris: No Visible !Finetayer ❑ % to 1" ? =~""' ❑ > 1" •

Description:

Setbacks N/A Floor. Debrs: ❑ No Visible/Fine Layer ❑ /2 to 1 1 ❑ >1 "

Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: )/_ 12002 Inspection Team: Name: Agency: ENTE E ' Name: Agency:

NYC-WTC 000101813