WTC facade inspection form, 107 Wall Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form -Premtse`Address: _ C o lt Block: I ResidentialD Commercial Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Manage ant: Telephone Number. Name: C-11( i FAX: Address: On Site Contact: Name: 4 O l ale hone Number. Building Owner Management Ac hies Interior Survey Performed ❑ Yes Q No Exterior Survey Performed ❑ Yes Q No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring O Yes ❑ No Locations: Copies of All Reports and Data Requested 0 Yes

Visual Inspection Results: Facade: Inspected Debris North South East [] N/A ❑N/A ❑ N/A ❑ Yes Q No Yes❑No DYesDNo ❑ No Visible/Fine Layer ❑ No Visible/Fine Layer Q%to1• D> /■ ❑ No Visible/Fine Layer ❑ 4 to 1' D>1' West ❑ N/A Yes ❑ No No Visible/Fine Layer Di4to1 E>10 Facade Description: /1 -

Roof

Debris: No Visible /Fine Layer 9 Va to 1' 9> 1' Description:

Setbacks N/A Ek Floor Debris: ❑ No Visible/Fine Layer [] y4 to 1' [3>1. Floor. Debris: ❑ No Visible/Fine Layer % to 1' 0>V Floor. Debris: No Visible/Fine Layer Va to 1' > 1' Floor. Debris: Q No Visible/Fine Layer Va to 1' > 1' Floor Debris: ❑ No Visible/Fine Layer Va to 1' > 1' Comments

Date: Inspection Team: Name: Agency: Name: Agency: ____ ENTEREO

NYC-WTC 000112646