Asbestos disposal and documentation form, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: —. r

Block: 3 Residential ❑ Commercial ❑ Name of Building: Lot: I Mix Use ❑ Other S L PcNN i # 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 Results: Facade: Inspected Debris North Ej N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1" '/2 ❑ > 1" South EN/A F2'S'es ❑ No [ "No Visible/Fine Layer El to 1" 1/2 ❑ > 1" East ❑ N/A ❑ Yes ❑ No ~o" Qo Visible/Fine Layer ❑'/2 to 1" ❑ > 1" •West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" FacadgDescription: _ f' Sc -\ S •\J -( '\ 1 VS (7 i C (L\ S A-T M -'&-

Roof

Debris: No Visible /Fine Layer 4 to 1" i ❑ > 1" Description: Ao rc Cor'c a Cut c.Q r\ rC 1DOc ( 1 Ct~ ,s

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

Comments A PAR 5 ° 4 VflCAN-t

Date: /J /2002 Inspection Team: Name: !O E ~; ~- Agency: 't 1 C L Name: i- ;i Agency:;I ' C 1 i

NYC-WTC-000113202