WTC visual survey form, 12 White Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: I ~ Block: Residential Commercial Name of Building: Lot 75O1 Mix UseD Otherfl # 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 0 No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes 0 No Locations: ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring ❑ Yes 0 No Locations: ' Copies of All Reports and Data Requested fl Yes

visual Inspection Kesulffi: Facade: Inspected Debris North ❑ N/A 0 Yes 0 No No Vsible/Fine Layer ❑'% to 1" 0 > 1" South ❑ N/A ❑ Yes 0 No 0 No Visible/Fine Layer 0 4 to 1" 0>1. East 0 N/A [j Yes 0 No No Visible/Fine Layer ❑ 14 to 1' West 0 N/A ❑Yes0 No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description: p p

Roof

Debris: Visible /Fine Layer .0 % to 1" 0>1. Description:.

Setbacks N/AC( Floor. Debris: No Visible/Fine Layer 14 to 1' 0>1. Floor _ Debris: No Visible/Fine Layer g 14 to 1" 0> 1" Floor.____ Debris: No Visible/Fine Layer ❑ % to 1" ❑ > 1" Debris: 0 No Visible/Fine Layer [] 14 to 1' Floor____ Floor____ Debris: 0 No Visible/Fine Layer ❑ 14 to 1" 8201 > 1" 9

Date: c/ 12002 Inspection Team: Name: Agency: Name: Agency: E'NTERE '

NYC-WTC 000110113