WTC environmental inspection form, 69 Warren St

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WTC Visual Survey Form Premise Address:

Block: Residential El Commercial J Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: 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 Kesults: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" ❑>1" East ❑ N/A ❑ Yes ❑ No El No Visible/Fine Layer ❑Y2 to 1" ❑> 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" ❑>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑'h to 1" ❑ > 1" Description:

Setbacks N/A ❑ 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" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Date: / /2002 Inspection by: Name: '-- Agency: Name: Agency:

NYC-WTC 000112979