DEP initial request letter for 19 Warren Street environmental assessments,

NYC 9/11 Public Portal Document

WT( Visual Survev Form Premise Address`. `^/

Block: Residential LI Commercial J Name of Building: Lot: Mix Use ❑ Other # of Stories: 5 AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( Address: On Site Contact: Name: ' Telephone Number: ( ) 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 ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: De ris North ❑ N/A Inspected

❑ 'es ❑ No Yes ❑ No Q No Visible/Fine Layer ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑'/2 to 1" 0>1" ❑ > 1" South ❑ N/A East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Description: p '/ ( U' .çivl /"u? Qo1L24 Roof 4

Debris: ❑ No Visible /Fine ayer ❑ /2 to 1 •1 Description: ' L &il/.i

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

c Agency: Date: /1/2002 Inspection Team: Nam • Name: an Agency•

NYC-WTC 000112697