WTC building inspection form, 65 Worth Street

NYC 9/11 Public Portal Document

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WTC Visual Survey Form I 7q 7'ç Premise Address:

Block: ) 39 Residential Commercial Name of Building: ( Lot: lO # of Stories: Mix Use Cj Other 0 AKA's:(,5-&7 2-t( Lg - Ors-7,,-1 Si r Building Owner/M narent Telephone Number. u

Name• FAX• Address: Id On Site Contact Name: ' Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No yes 0 No Exterior Survey Performed Dyes IA General Clean Up 0 Yes L " Locations: ACM Clean Up ❑ Yes M*o Locations: Air Monitoring ❑ YesD'flo Locations: Copies of All Reports and Data Requested Yes

Visual lnsoectlon Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ ra to 1" ❑ > 1" South ❑ /A [,.Yes ❑ No D No Visible/Fine Layer 34 to 1" 0>10 East West [3N/A ❑ N/A s ❑ No HYZsE:] No ❑ No Vsible/Fine Layer 034t01 9 No Visible/Fine Layer ❑ a to 1" 0>1' 0>1' Facade Description:

Roof

Debris: [3No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description: fri 40 Lie-AI.

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" 0,10 Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" 0:1.10 Floor: Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer Q14 to 1" 020-10 Floor Debris: 0 No Visible/Fine Layer 14 to V ❑ > 1"

Comments

Date: /2002 Inspection Team: Name: Agency: DAP Name: Agency:

NYC-WTC-000111043