WTC building inspection form, 14 Maiden Lane

NYC 9/11 Public Portal Document

W WTC Visual Survey Form tonlnq I Premise Address:

Block: ( f Residential J Commercial D Name of Building: Lot: 3 Mix Use I Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: 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 J Yes visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0%t01" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No VSible/Fine Layer ❑%to 1" 0>1" West ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer 0%to1" 0>1" Facade Description: _ 4L 0L Roof Est; Debris: ❑ No Visible /Fine yer ' ❑'/ to 1" •4 =l'~"` 1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1"

Date: '3 /t12002 Inspection Team: Name: -~ Agency: Name: Agency:

NYC-WTC 000101942