WTC building inspection form, 5 Worth Street

NYC 9/11 Public Portal Document

691 WTC Visual Survey Form /O7 Premise Address: Block: `7- I Residential Commercial p 1Name of Building: y~ Lot: Mix Use Other # of Stores: AKA's: BuHdIpgOwneManjemit Telephone Number. ( ) Name: f dM Address: • On Site Contact: Name: Telephone Number: Building Owner Management Activities Interior Survey Performed 0 Yes 0 No Exterior Survey Performed 0 Yes 0 No General Clean Up 0 Yes 0 No Locations: l/ ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring 0 Yes 0 No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North J3'N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑htol" 0>1" South ❑N/A [ esDNo o Visible/Fine Layer ❑ % to 1" 0>1" East 041/A ❑ Yes 0 No O Visible/Fine Layer No ❑htol" 0>1" West [1/A 0 Yes 0 No ❑ No Visible/Fine Layer ❑%tol" 0>1" Facade Description:

Roof Debris: Q'fyo Visible /Fine Layer 0 % to 1" 0 > is Description:

Setbacks N/A [~ Floor Debris: 0 No Visible/Fine Layer ❑ th to 1" Floor Debris: 0 No Visible/Fine Layer 0 % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer 0 ih to 1" 0 > 1" Floor Debris: 0 No Visible/Fine Layer 0 6 to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" 0 > 1"

Comments

Date;,_, 'I ' 12002 Inspection Team: Name: L~ Agency: Name: Agency:

NYC-WTC 000110994