Asbestos inspection form, 71 Worth Street, Oct 2001

NYC 9111 Public Portal Document

WTC Visual Survey Form Premise Address: Block: Residential 0 Commercial Name of Building: Lot MixUseD Other S of Stories: AKA's: Building OwnerlManagement: Telephone Number ( ) Name: FAX Address: On Site Contact Name: ' ' 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 Q Yes ❑ No Locations: Copies of All Reports and Data Requested J Yes

Visual Inspection Results: Facade: Inspected Debris North N/A Yes No No Visible/Fine Layer ❑ % to 1' > 1' South N/A Yes No No Visible/Fine Layer 'i4toV >1' East WA Yes No No Visible/Fine Layer ❑%t 1- >1' West N/A es No No Visible/Fine Layer ❑ % to 1' 3,110 0 Facade Description: () ~ ft

Roof Debris: t No Visible !Fine Layer .fl i4 to? ' 0>1. Description:

Setbacks Floor _N/Ac Debris: No Visible/Fine Layer % to? >1. Floor____ Debris: No Visible/Fine Layer % to 1' > 1' Floor____ Debris: No Visible/Fine Layer % to 1' > 1' Floor____ Debris: No Visble/Fine Layer % to 1' >1' Floor___ Debris: No Visible/Fine Layer % to 1' > 1'

Date: )=f2002 Inspection Team: Name: Agency. Name: Agency:

NYC-WTC-000111046