WTC Facade Inspection Form, 134 West Broadway

NYC 9/11 Public Portal Document _/ vv i V viouai ourvev rurm Innt -c•rc; Premise Address: 3 \ Block: !'i'1 Residential Comore Name of Building: Lot 30 MixusejJ Other # 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 D Yes No Locations: r]

Copies of All Reports and Data RequestedIJ Yes

Visual Inspection Results: Facade: Inspected Debris North N!A Yes No No Visible/Fine M to l' al' South N/A es No No Visible/Fine Layer M to 1' a 1' East NIA Visible/Fine Layer M to 1' a 1' West NIA Yes No No Visible/Fine Layer LayerH%tol, Hao1' Facade Description:

Root Debris: Visible /Fine Layer j'] 36101. t] a 1' Descnp '

Setbacks WAD Floor_ Debris: No VisiblelFine Layer M to l' '1' Floor._ Debris: No Visible/Fine Layer M to1' a 1' Floor._ - Debris: No Visible/Fine Layer M to 1' a 1' Floor:_ Debris: No Visible/Fine Layer M to l' al' Floor___ Debris: No Visible/Fine Layer M to1' al' Comments

Date: =1 1 002 Inspection Team: Name: ` "' ' Agency: dame: Agency

NYC-WTC 000109651