DEP letter requesting environmental assessments, Feb 2002

NYC 9/11 Public Portal Document

WTG Visual Survey Form premise Address: \

Block: Residential Comme ial ame.of Building: ' ,. Lot: Mix Use J Other - '- C _✓, # of Stories: AKA's: I J Building Owner/Management: Telephone Number: (z , L ) f _ '- Name: FAX: Address: On Site Contact—,. Name: 'r ~~- ' ` Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean U es ❑_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 ebris North ❑ N/A EYes ❑ No No Visible/Fine Layer ❑'/2to1" 0>1" South n -N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ 1/2 to l" 0>1" East -9'N/A ❑ Yes ❑ No .No Visible/Fine Layer ❑'/ to 1" 0>1" West ❑ N/A ❑'Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" 0>1" Facade Description:

Roof

Debris: ~No Visible /Fine Layer ❑ % 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 ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: Inspection Team: Name: Agency: L1 Name: Agency:

NYC-WTC 000113432