WTC visual survey form, 1 Peck Slip, Sept 2001

NYC 9/11 Public Portal Document

• 10©t3co3 ITC Visual Suivey Form Premise Address:

Block: oc t— ResidentiatjJ l Commercial gei QL[ P Name of Building: Lot: 3 Mix UseD Other # of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: S FAX: Address: On Site Contact: Name: " • i t telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes Q No Exterior Survey Performed j] Yes No General Clean Up Yes No Locations: ACM Clean Up Yes No Locations: Air Monitoring []Yes[JNo Locations: Copies of All Reports and Data Requested Yes

Visual inspection Results: Facade: Inspected Debris North N/A Yes j] No No Visible/Fine Layer to 1' 0>1' South N/A Yes No No Visible/Fine Layer h to 1' 0>1' East N/A Yes No No Visible/Fine Layer o >1' West N/A fl Yes No No Visible/Fine Layer H34to 1■ H 31, 1 0 Facade Description: (') 0

Roof

Debris: No Visible /Fine Layer 936 to 1' 9>1' Description:

Setbacks N/A Floor Debris. No Visible/Fine Layer 'Y: ts 1 > Floor____ Debris: No Visible/Fine Layer 3~4 to 1' >1' Floor____ Debris: No Visible/Fine Layer 34 to 1' >1' Floor____ Debris: No Visible/Fine Layer 36 to 1' > 1' Floor. Debris: No Visible/Fine Layer 3~4 to 1' >1' Comments

• Date: 14.f 1: 4.0 /2002 Inspection Team: Name: Agency: ______ Name: _Agency:__________ ENTERED

NYC-WTC 000115056