WTC exterior inspection form, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survav Form Premise Address: L-1- (4 PA s

Block: Residential 0 Commercial Name of Building: Lot: MixUseD Other # 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 ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up 0 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested 0 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑> I South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 34 to 1" 0>? East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0'r4 to 1 0>1 West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1W Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer 034 to? 0>? Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ i4 to? ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ h to? ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to? 0>1' Comments

Date: / /2002 Inspection by: Name: C.. 1— _ Agency: Name: Agency:

NYC-WTC 000110900