Law Department divider sheet for WTC documents

NYC 9/11 Public Portal Document

WTC Visual Survey Form l00`~3Co (~ Premise Address: q1L.7 LS -' Block: Residential Commercial J Name of Building: Lot: Mix Use j 1 Other # of Stories: AKA's: — Building O er/Management: Telephone Number: ( ) Name: CL-. c-- FAX: Address: Jr . ¢, — D 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof s~

Debris: kNo Visible /Fine yer ❑ % to 1" •1 ❑ > 1" Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1" ❑ > 1"

Comments

Date: cIN J T1 oh Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000101838