WTC Building Inspection Form, 2002

NYC 9111 Public Portal Document

WTC Visual Survey Form IC) 0I C'4 b Premise Address: t2c 1... C -r T+(2 Ee r Block: 52, Residential 0 Commercial9 Name of Building: Lot: 0- 1 Mix Use Other 125 C €b # of Stories: 1 AKA's: I2 5 2 Building Owner/Management Telephone Number: (-11€) 1-3b -O J Name: MAS i O _ y2 7 a

' \b. FAX: ? IS 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 9 Yes ❑ No Locations: Copies of All Reports and Data Requested Dvs Visual Inspection Results: Facade: Inspected Debris North 0 N/A 0 Yes ❑ No No Visible/Fine Layer 7 to1• /: ❑ >1• South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ 34 to l' 0>10 East 0 N/A DYes ❑ No No Visible/Fine Layer ❑ % to 1" 0>10 West ❑N/A ®Yes9No fN o Visible/Fine Layer ❑ 34 to 1' 0>1' Facade Description:

Roof

Debris: ONo Visible /Fine Layer ❑ y4 to 1' 9> 1' Description:

Setbacks N/P,jJ Floor Debris: .No Visible/Fine Layer 4 to 1" 0>1' Floor.____ Debris: No Visible/Fine Layer % to 1' 0>10 Floor:____ Debris: ❑ No Visible/Fine Layer 4 to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer Floor Debris: ❑ No Visible/Fine Layer 0 34 to 1" 34 to 1' ❑ > 1" 9 , 1'

Date: n 1 12002 Inspection Team: Name: Name:

NYC-WTC 000107449