Asbestos inspection form, 75 Worth Street, Oct 2001

NYC 9/11 Public Portal Document

I/ WTC Visual Survey Form Pr.i iss Address: c

Block:'" ResidentialU Commercial Name of Building: Lot: Mix Use 0 Other * of Stories: AKA's: Building Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact: Name:' Telephone Number Building Owner Management Activities Interior Survey Performed ❑ Yes 0 No Exterior Survey Performed 0 Yes 0 No General Clean Up Yes No Locations: ACM Clean Up 0 Yes No Locations: Air Monitoring ❑ Yes 0 No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes 0 No No Visible/Fine Layer ❑ i4 to 1' 0>? South ❑ N/A ❑ Yes 0 No No Visible/Fine Layer 0Ato1' ❑>1- East ❑N/A ❑Yes0No No Visible/Fine Layer ❑%to1' ❑>10 West a N/A Yes Q No No Visible/Fine Layer ❑ y4 to 1' 0>? Facade Description: (2 LI n

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

Setbacks N/A Floor Debris: 0 No Visible/Fine Layer Va to 1' 0>1. Floor: Debris: 0 No Visible/Fine Layer % to 1' > 1' Floor Debris: 0 No Visible/Fine Layer % to 1' 8301' Floor____ Floor _ Debris: 0 No Visible/Fine Layer Debris: 0 No Visible/Fine Layer % to V % to 1' H ❑ > 1' > 1'

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Date: Inspection Team: Name: Agency. Name: Agency:

NYC-WTC 000111049