WTC debris inspection form for commercial building, 2002

NYC 9/11 Public Portal Document _. -.y .~__.•__.,~_. .. .-..dr~vr._- - — L. ...... ... -f._... . .

WTC Visual Survey Form X07$491 Premise Address: Lf 3 Block: Residential Commercial J Name of Building: Lot: Mix Use Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number: (Z ('L) 2 3S- Name: M ) FAX: ( ) Address: On Site Contact: Name: - t • ., Telephone Number: i `Z) 27 5 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 El Yes ❑ No Locations: Copies of All Reports and Data Requested j l Yes

Visual Inspection Results: Facade: I s ected Debris North ❑ N/A es ❑ No No Visible/Fine Layer ❑'/Z to 1" ❑ > 1" South ❑ N/A es ❑ No No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" East ❑ N/A s ❑ No No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" West ❑ N/A P 4 s ❑ No No Visible/Fine Layer ❑ / to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer /2 to 1" ❑ > 1" Description: A_I R. i IJ it cv - F pS -Tc~

~ - n Setbacks N/A ❑ S v%& , ; r Q. led a C -0(1 UCQ,~S S, Floor: Debris 10 Visible 9ne La er ❑ % to 1" ❑ > 1" Floor: Debris. ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [:]> 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ /Z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Comments

Date: Inspection by: Name: Name: Agency:

NYC-WTC 000112038