Building contamination assessment form, Sept 2001

NYC 9/11 Public Portal Document

looIoo(o WTC Visual Survey Form Premise Address: WUL► s-r Block: 4Q I Residential 0 Commercial o I Name of Building: Lot: Mix Use ❑ Other J # of Stories: AKA's: Building Own r/M agement: Telephone Number: Ø . - Name: C Ob LUD r c- Address: On Site Contact: Name: a _ Telephone Number: ( l ) - So 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 ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A es ❑ No ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1" South ❑ N/A RYes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A RYes ❑ No ❑ No Visible/Fine Layer ❑'/a to 1" 0>1" Facade Description:

h Roof r-Q OIM cO Debris: ❑ No Visible /Fine Layer ]'/ to 1" 0>1" S*cu(''')Q-k\ Description: Aij~~ r.

Setbacks N/A' - Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1"

Date: / /2002 Inspection by: Name: Agency: NICE P Name: Agency: II

NYC-WTC-000110223