Environmental hazard assessment form, 233 Water Street

NYC 9/11 Public Portal Document

TT T ~r~TC Visual Surve Form Premise Address:

Block: Residential 0 Commercial Name of Building: Lot: Mix Use 0 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1' South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'% to 1' 9>1' East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1' West ❑ N/A [] Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 9>1' Facade Description: () A ,. n

Roof

Debris: No Visible /Fine Layer 0 % to 1' ❑ > 1" Description:

Setbacks N/A( Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1' Floor. Floor. Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' Debris: ❑ No Visible/Fine Layer ❑ % to 1' 9> 1'

Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" E1> 1' Floor. Debris: ❑ No Visible/Fine Layer 9% to 1' ❑ > 1'

Comments

Date: Inspection Team: Name: Agency: Name: Agency: ENTERED

NYC-WTC 000113789