WTC exterior inspection form, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form I 001 premise Address: Block: Residential Commercial Name of Building: Lot: Mix Use Other .. - # of S ries: AKA's: Building Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact Name: Telephone Number t 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 p Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0½ to 1" [>1 South ❑ N/A ❑ Yes ❑•No ❑ No Visible/Fine Layer ❑ % to 1" 0>10 East 0 N/A ❑ Yçs 0 No ❑ No Visible/Fine Layer ❑ % to 1" 0>10 West 0 N/A es ❑ No ❑ No Visible/Fine Layer [J..% to 1" ❑ > 1" Facade Description:

Roof

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

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to? 0>10 Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to I 0>10 Floor. Debris: ❑ No Visible/Fine Layer ❑'h to 1" 0>? Comments

Date: / .) /2902 Inspection by: Name: ( Agency: Name: Agency:

NYC-WTC 000110938