WTC building inspection form, unidentified site

NYC 9/11 Public Portal Document

WTC Visual Surve Form Premise Address: a ~

Block: I B Residential Commercial J Name of Building: Lot: pO Mix Use D Other 2 S uC # of Stories: AKA's: O - 7oy1IA)((fl (-)4- 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 0 Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Yes ❑ No III No Visible/Fine Layer ❑%to 1" 0>1" South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑Y2to1" 0>1" East ❑ N/A J Yes ❑ No No Visible/Fine Layer El%s to 1" 0>1" West ❑ N/A UYesDNo No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ % to 1" 0>1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer E]1/2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" [1> 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Date: ~ 12002 Inspection by: Name: G !^ o Agency: Name: Agency:

NYC-WTC 000109759