WTC building facade inspection checklist form, 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 too Premise Address: W L► ' -r Block: 0 Residential ❑ Commercial ❑ Name of Building: Lot: Mix Use ❑ Other L CL4 p.g # of Stories: 3 AKA's: Building Own r/M agement: Telephone Number: (,,ll 01 Name: k ' .) W ryes-S [,~ L( ( ) Address: v~ On Site Contact: Name: çcxs iiv e&1 Telephone Number: ( I ) 9,5c? I 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 RYes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" West ❑ N/A RYes ❑ No ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" Facade Description:

Roof q V 1 -\

Debris: ❑ No Visible /Fine Layer E] 16 to 1" ❑ > 1" S*O c Cti - Description:

Setbacks N/A9- Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer El /2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1"

('k

Date: a/ /2002 Inspection by: Name: Agency: /J'IctEP Name: Agency:

NYC-WTC-000110225