Facade inspection form, 40 Peck Slip, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form IOOJ33' ' Premise Address: — Block: i q -7 Reside tial Commercial Name of Building: Lot: 3 Mix UseEJ Other LA,4 mAz~ # 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 E] No General Clean Up ❑ Yes No Locations: ACM Clean Up - ❑ Yes No Locations: Air Monitoring ❑ Yes j] No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris > North N/A 0 Yes No O No Visible/Fine Layer South East N/A N/A ❑ Yes g No [] Yes Q No No Visible/Fine Layer No Visible/Fine Layer 0'~ / to 1ww to 1 ' >1 w 1w

'

West N/A r,] Yes [] No ❑ No Visible/Fine Layer H /4 34 to 1' L] >r Facade Description: (1 A D

Roof Debris: g No Visible /Fine Layer 0 V to V 9> 1' Description:

Setbacks N/A, Floor: Debris: No Visible/Fine Layer ❑ % to 1' > 1' Floor: Debris: No Visible/Fine %4 to 1' > 1' Floor. Debris: No Visible/Fine Layer 34 to 1' >11 Floor: Debris: Q No Visible/Fine Layer % to 1' >1' Floor: Debris:(] No Visible/Fine Layer LayerH%tol" > 1'

Comments

Date: _/ l{/2D02 Inspection Team: Name: _f Agency: Name: Agency:______ E N T E R E D •

if NYC-WTC 000115019