WTC building assessment form with facade and ACM documentation

NYC 9/11 Public Portal Document

WTC Visual Survey Form +°L (00 (0 L Prg Addres (;_J Block: 'ç.,, Resident — Commercial Name of Building: Lot: Mix Use J Other # of Stories: AKA's: — ,, — ; -Crc Building Owner anagement~ 1 elep o e Number: ( ) Name: aN FAX: ( ) D Q Address: On Site Contact: Name: " Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed EYes ❑ No General Clean Up Yes ❑ No Locations: 'C ACM Clean Up ❑ Yes No Locations: Air Monitoring ❑ YesJ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: _ Inspected Debris North 14/A Yes ❑ No ❑ No Visible/Fine Layer Y2 to 1" ❑ > 1" South N/A E yes ❑ No ❑ No Visible/Fine Layer /2 to 1" ❑ > 1" East -E N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ N/A RYes ❑ No ❑ No Visible/Fine Layer 1 6 to 1" ❑ > 1" Facade Description:

Roof

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

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer fl 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

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

NYC-WTC 000108283