WTC debris inspection form for residential building, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Prernlse Address: ~ I LJ - 7 Block: 'Residential O Commercia NaNamq of B din : Lot: Mix Use O Other ,' # of Stories: AKA's: Building agem t• 'Telephone Num PII Name: a ~IM..a — (7 WI t) FAX:( Address: On Site Contact: _ Name: 1C k ll` t-rl~ k ~ Tele one ber. PII Building Owner Management Ativlties Interior Survey Performed s ❑ No Exterior Survey Perf ed es ❑ No r General Clean Up, Yes No Locations: Q~ 'C ACM Clean Up Yes ❑ No Locaapns: Air Monitoring Ves ❑ No 'Locations:__________________________________________ Copies of All Reports and Data Re ueste es Visual Inspection Results: Facade: Inspected Debris North ❑ N/A FJ.YesDNó No Visible/Fine Layer ❑ % to l" O>1W South ❑ N/A Yes❑No No Visible/Fine Layer ❑ 16 to 1" ❑ > 1" East ❑ N/A f;Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A J Yes❑No No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Vi • le ine Layer ❑ i f to 1" 1" Description: ~~ s

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" Floor. Debris: O No Visible/Fine Layer ❑ 14 to V 0>? Floor. Debris: ❑ No Visible/Fine Layer ❑ 4 to? O>1' Floor: Debris: ❑ No Visible/Fine Layer ❑ 14 to? O > 1 ' Floor. Debris: ❑ No Visible/Fine Layer O1A to 1' > 1' Comments yLc (ti 0L L '

GIS ,,,,. L/4i S ,,- w 44' /«.ran S•l 1~

Date: I A g 12002 Ins coon Team: Name: Tc Agency: C~ Name: Agency:

NYC-WTC-000112031