WTC Facade Inspection Form, 136 West Broadway

NYC 9/11 Public Portal Document Iry Premise Address: u.

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I ioc:k: Residentia Commercial Name of Building: Lot Mix UseD Otherfl 0 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: Jr Monitoring I] YesI] No Locations: Copies of All Reports and Data Requested DY.s Visual Inspection Results: Facade: Inspected . Debris North NIA Yes No No Visible/Fine Layer 34 to 1' > 1' • South NIA Yes No JJ No Visible/Fine Layer 14to? > 1' East NIA No Visible/Fine Layer 34 to 1' > 1''- West NIA Yes No No Visible/Fine Layer 34 to 1' H301' Facade Description:

Roof Debris: $] No Visible /Fine Layer r,] 34 to1'. D' 19

Setbacks OVA=] Floor_ Debris: No Visible/Fine Layer %to 1' al' Floor_ Debris: No Visible/Fine Layer 34 to 1' > >' Floor___ Debris: No Visible/Fine Layer 3* to 1' > 1' Floor:____ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor_ Debris: No Visible/Fine Layer 34th? '1' Comments

Date: _) 1_jflOO2 inspection Team: Name: r✓ IY r — L Agars. Name: Agency-____ T.ER _ . •

NYC-WTC 000109659