DEP request for environmental data, 109 Washington Street, Feb 2002

NYC 9/11 Public Portal Document

1 WTC Visual Survey Form Premise Address: ' r

Block: Residential Commercial, Name of Buildin Lot: Mix Use Other ~% 4 ~!. # of Stories: Z AKA's: Building Own Management: Telephone Number: ( ) Name: cam}-- 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 D Yes

Visual Inspection Results: Facade: Inspected Debris North - 'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ >,1" South N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A &es ❑ No ;.No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Description:

Roof

Debris: -No Visible /Fine Description:

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

Date: / /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000113602