DEP letter requesting WTC hazard assessments, Feb 2002

NYC 9/11 Public Portal Document 1NTC Visual Survey Form Premise Address: '

Block: M,. Residential $f e;•v Commercial I Name of Building: Lot: Mix Use Other # of Stories: s AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: Name: * m Telephone Number: (Zr,. ) 6 or - Building Owner anagement ctivities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

visuall inspection , esuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fl a er ❑ % to l" 0>1" South ❑ N/A © Yes ❑ No No Visible/ me Laye ❑'/%tol" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof E t; Debris: No Visible i e ❑ % to 1" 4 A-"'4 ❑ > 1" / Description:

Setbacks N/A Floor: 5a Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'% to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments /~N f w M1, ar 4 J . J.

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Date: _/2/2002 Inspection Team: Name: Agency: US CEP Name: • Th' i! c Agency: /VKC p_P jc'p-ic NYC-WTC 000112680