WTC debris inspection form, 21 Maiden Lane

NYC 9/11 Public Portal Document

WTC Visual Survey Form -8t*100 10'' Premise Address: I _03 a

I aI ct e n a - e_ Block: (oS Residential 0 CommercialD Name of Building: Lot: Mix UseD 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 insoection Kesuits:

Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer J34 to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer j J % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Ya to 1" 0>1" West ❑N/A ❑Yes❑No ❑ No Vsible/Fine Layer Ya to 1" 0>1" Facade Description: t - -

Debris: ❑ No Visible /Fine Layer to1" ❑>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 034 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: (7 / i2OO2 Inspection by: Name: 11P Agency: DEP Name: Agency:

NYC-WTC 000102121