Correspondence form, NYC DEP, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form I Promise Ad ress:

Block: Residential 0 r( -------) Commercial '7 ie 1- Name of Building: q1 t j' ' / Lot: Mix Use ❑ Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: — On Site Contact: Name: ' Vi L , '3L Telephone Number: (71..-) ~" f-4 (f Building Owner Management ctivities Interior Survey Performed ❑ es ❑ 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 o Visible/Fine Layer ❑ Y2 to 1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ V to 1" East ❑ N/A ❑ Yes ❑ No PNo Visible/Fine Layer ❑ Y2 to 1" West ❑ N/A O Yes ❑ No ONo Visible/Fine Layer ❑ Y2 to 1" Facade Description: ?t' : __

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ~] > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑V: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 ❑ V to 1" ❑ > 1" Comments

O fl L '

Date: / /2002 Inspection Team: Name: Agency Name: Agency:

NYC-WTC 000105505