200 RECTOR PL 1065475, 16/7508

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 2 o .c —Co" ~I Block: Residential Commercial Name of Building: Lot: Mix Use f J Other # of Stories: 3 AKA's: Building Owner/Manag menj: Telephone Number: ( •Z 7; I Name: FAX: Address: On Site Contact•., L 01j ' — Name: L -S ) --s,J Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ® Yes ❑ No Exterior Survey Performed [ Yes ❑ No General Clean Up EYes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring 2Yes ❑ No Locations: Copies of All Reports and Data Requested Yes i

visual inspection Kesuits: Facade: Inspected ebris North ❑ N/A DYes ❑ No No Visible/Fine Layer ❑ to 1" '/2 ❑ > 1" South ❑ N/A fYes ❑ No No Visible/Fine Layer ❑ to 1" '/2 ❑ > 1" East ❑ N/A ❑ Yes ❑ No I J No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ N/A [Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Description:

Roof - Debris: ❑ No Visible /Fine ayes ❑'/2 to'1" •7 ~"''~ 1" Descrintinnr

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer [] % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments fc~

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Name: s' — Agency:

NYC-WTC- 000114138