Asbestos inspection form, 57 Worth Street, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premisp ~ ►ddXss: O CJL Block: Residential p Commercial Name of Building: Lot: Mix UseD Other S of Stories: AKA's: Building O~vner/M agement Telephone Number Name: N' \ S FAX:( Address: On Site Conte Name: ' ' 'ice' C Telephone Number. 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 0 Yes

Visual Inspection Results: Facade: Inspected Debris North N/A Yes No No Visible/Fine Layer ❑ % to 1' 9'? South N/A Yes No No Visible/Fine Layer % to 1' > 1' East N/A Yes No No Visible/Fine Layer 34to1' >1' West N/A HYesoNo, No Visible/Fine Layer ' 6to 1• 0>1k Facade Description: a () A

Roof Debris: No Visible/Fine Layer .JJ % to 1 9>1' Description:

Setbacks WA Floor.___ . Debris: No Visible/Fine Layer 34 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 % to 1' '1' Floor.___ Debris: No Visible/Fine Layer % to 1' > 1' Comments

Date: ~/ 002 Inspection Team: Name: - f ---- Agency: Name: Agency:

NYC-WTC-000111031