WTC building inspection form, 22 Maiden Lane, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form .'(:00 103 Premlee • Address•

Blok: Residential 0 Commercial Name of Building: Lot Mix Use 0 Other ,. 4.

# 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 % to 1" 0>1" South ❑ NIA ❑ Yes ❑•No ❑ No Visible/Fine Layer '/ to l" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer V to 1" 0>1" West ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" []>I" Facade Description:

Roof

Debris: []No Visible /Fine Layer '/ to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0 Y to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑Y2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0 to 1" ❑ > 1" Comments

Date: Inspection by: Name: Al,. Agency: Name: Agency:

NYC-WTC 000102159