Facade inspection form, 23 Peck Slip, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual

Survey Form Premise Address:

Block: t Residential 0 Commercial Name of Building: Lot: &J Mix Use 9 Other # of S ories: AKA's: Building Owner/Management Telephone Number. ( ) Name: S 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: !ns ected Depris North 0 N/A BYes ❑ No No Visible/Fine Layer ❑'/atol" 0>1" South ❑ N/A ❑ No o Visible/Fine Layer ❑ / to 1" 0>1' East ❑ N/A ❑ Yes ❑ No O Visible/Fine Layer No ❑Y to 1" 0>1" West ❑ NIA 0 Yes ❑ No ❑ No Visible/Fine Layer ❑Mato 1" ❑> 1" Facade Description:

Roof

Debris: &(No Visible /Fine Layer ❑ Ya to 1" 0> 1" Description:

Setbacks N/A [] Floor Debris: ❑ No Visible/Fine Layer 0 V to? 0>1' Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1' Floor: Debris: ❑ No Visible/Fine Layer ❑'/a to 1" 0>1' Floor Debris: 0 No Visible/Fine Layer i/ to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer 0 %a to 1" 0>1' Comments

3 Inspection Team: Name:Vci, _. j Ro6 . *n Agency: Name: Agency:

NYC-WTC-000115037