53 WORTH STREET; BN# 1001958; Block: 176; Lot: 4

NYC 9/11 Public Portal Document

S WTC Visual Survey Form Premise Address: ~t -f-4-L r Block: 17 Residential p Commercial Name of Building: Lot: Mix Use 0 Other s; S of Stories: AKA's: Building Owner!Manftgement Telephone Number. Name: Aw FAX: Address: On Site Contact: Name: ' ' Telephone Number Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes 0 No General Clean Up ❑ Yes 0 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 ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑3 to 1 0>1' South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ i4 to 1' 0>1' East ❑ N/A g Yes ❑ No Q No V isible/Fine Layer ❑ i4 to 1' 0>1" West ❑ N/A ❑ Yes ❑ No n ❑ No Visible/Fine Layer ❑ y4 to 1' 0>1' Facade Description: O „

Roof Debris: TNoVisible /Fine Layer •D'r4 to 1' 9>1' Description:

Setbacks N/A~ Floor___ Debris: ❑ No Visible/Fine Layer ❑ 34 to? 0>1. Floor Debris: ❑ No Visible/Fine Layer ❑ 34 to 1' 9>1' Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1' 0>1' Floor Debris: ❑ No Visible/Fine Layer a 34 to? > 1' Floor Debris: ❑ No Visible/Fine Layer ❑ 34 to 1' 831018

Comments

. IDate: =/ 002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000111026