WTC Facade Inspection Form, 175 West Broadway

NYC 9/11 Public Portal Document

WTC Visual Survey Form I®3/ Prerrsiise Address:

Block: 1 7 h ResidentialD Commercia 1 Name of Building: S ,Q ) Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Man ement 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 0 No Locations: ACM Clean Up g Yes 9 No Locations: Air Monitoring D Yes ❑ No Locations: Copies of All Reports and Data Requested Q Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes No O No Visible/Fine Layer %to 1' 0.1' South East West ❑ N/A ❑ N/A N/A a DYes No Yes No Yes O No No Visible/Fine Layer No Visible/Fine Layer i4 to 1' 'r4 to 1' No Visible/Fine Layer ❑ % to 1' H)o 0:1' 1' ❑ > 1' Facade Description: n0 A

Roof Debris: ENo Visible /Firm Layer .t] % to 1' 9>1' Description:

Setbacks WA Floor. Debns: U No Visible/Fine Layer % to 1' >1 Floor____ Floor. Floor. H Debris: No Visible/Fine Layer Debris: No Visible/Fine Layer Debris: No Visible/Fine Layer i4 to 1' %tot' ito1' >1' >1' >1. Floor.____ Debris:F]No Visible/Fine Layer % to 1' >1'

Comments

Date: 5 it _/2002 Inspection Team: Name: ' Agency: Name: Agency:

NYC-WTC 000109683