WTC debris inspection form for residential building, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Prent14se Address: ~ A ~ I~ ' a ~ ~ QS 7 Block: 'Residential 0 Commercia Namq of 8 din : ~~ Lot: Mix Use Other * of Stories: AKA's: .So Building Wagempt: _ 1 elephone Name: a 64 FAX• W— v Address: On Site Contact: Name: I CK Lj 119 ti(/~l'I'•I'k Tele one ber. P11 Building Owner Management AtIvfties Interior Survey Performed s ❑ No Exterior Survey Perf ed es ❑ No General Clean Up, Yes No Locations: ?s 'C ACM Clean Up Yes ❑ No LocaXpns: Air Monitoring Yes ❑ No 'Locations:_________________________________________ Copies of All Reports and Data Re ueste es Visual Inspection Results: Facade: Inspected Debris North ❑ N/A es❑No No Visible/Fine Layer ❑ % to l" ❑ > 1" South ❑ N/A IFes ❑No No Visible/Fine Layer ❑ 4 to 1" ❑ > 1" East ❑ N/A ;Yes ❑ No No Visible/Fine Layer ❑ V: to 1" ❑ > 1" West ❑ N/A J Yes❑No No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof Debris: ❑ No Layer Description: C ❑ifto1" 1"

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" > 1" Floor. Debris: 0 No Visible/Fine Layer ❑V:to 1" H;10 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ 1410 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" Floor. Debris: ❑ No Visible/Fine Layer 014 to 1" D> > 1" 1" Comments

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Date: I 1,_S 12002 Team: Name: Cr3 . Tc 4 Agency:_______ Name: Agency:

NYC-WTC-000112031