200 RECTOR PL 1065475, 16/7508

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1/ Premise Address:

Block: Residential Commercial J Name of Building: Lot: Mix Use J Other # of Stories: 3 AKA's: Building Owner/Manag menj,: Telephone Number: ( `) Z ; l Name: FAX: Address: On Site Contact• Name: ~ v~.g (._) -& .,. t.c' 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 'Yes ❑ No Locations: Copies of All Reports and Data Requested Yes i

visual inspection rcesuits: Facade: Inspected ebris North ❑ N/A DYes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" South ❑ N/A f Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'A to 1" ❑ > 1" West ❑ N/A [Yes ❑ No No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Facade Description:

Roof ~,, s t, i i'

Debris: ❑ No Visible /Fine ayes 0'/2 t0'1" .1 E > 1" 1 Descrintionv

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

Comments 4 1

ri • 1 / Tee..,• A/.f.,,a• • ------- VTP

Name: -L, — Agency:

NYC-WTC- 000114138