WTC debris inspection form for residential building, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercia Namqof B din : Lot: Mix Use Other # of Stories: AKA's: c ULL J ' -' ° Building O agemgit: t elephone Num r: Pii -...> Name: - LM' FAX: Address: On Site Contact: Name: 1q K ~141~(l`~I'~'k Tele one I ber P Building Owner Management ptivlties .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. Interior Survey Performed s ❑ No Exterior Survey Perqrmed aYes ❑ No t General Clean Up Yes ❑ No Locations: ?- _t i" -i i c ACM Clean Up Yes ❑ No Localpns: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Roqueste Yes Visual Inspection Results: Facade: Inspected Debris North Q N/A Yes ❑ No No Visible/Fine Layer ❑ V2 to 1" O>1" South ❑ N/A IR Yes Q No No Visible/Fine Layer ❑ V to 1" ❑ > 1" East ❑ N/A UYes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible (Fine Layer ❑ Y to I" >1" Description: ti

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1" Comments

~i . f-V" - --- 1 ' 4A3 ' Lan ,4 l 4

(-)', Y1d' er + w.r~ k r,. usZ Date: /A g 12002 Ins ction Team: Name: CL Agency: c Name: Agency: C-3 NYC-WTC 000112044