WTC inspection form, 83 Maiden Lane, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form 814* 10011% 1 Premise Address: Q3 Maiden Lane Block: (a8 Residential, i Commercial p Name of Building: 17 Lot Mix UseD Other 0 of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: Telephone Number: Building Owner Manageptent Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up 0 Yes 0 No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data RequestedD Yes Visual Inspection Results: Facade: Inspected Debris North ❑ NIA ❑ YesQNo ❑ No Visible/Fine Layer IV34 to1" 0>1' South ❑ N/A ❑ Yes [] No ❑ No Visible/Fine Layer 1/ 2 tol " 0>1" East 0 N/A ❑ YesQNo ❑ No Visible/Fine Layer t134 t0 ? 0>1" West ❑N/A []YesQNo ❑ No Visible/Fine Layer '/tol" j]>1" Facade Description:

Debris: Visible /Fine Layer 034t01" 0>1" Description:

Setbacks NIA ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" D>1" Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" ❑ >1" Floor: _ Debris: ❑ No Visible/Fine Layer ❑ % to 1" [j >1" Floor: Debris: ❑ No Visible/Fine Layer 034 to 1" 0>1" Floor. Debris: No Visible/Fine Layer j] 4 to 1" 0>1" Comments

Date: I /(012002 Inspection by: Name: _A P Agency DS P V Name: Agency:

NYC-WTC 000102462