WTC building asbestos and condition survey form, DEP

NYC 9/11 Public Portal Document

` WTC Visual Survey Form Premise Address: .~.. 3 , e. Block: Residential Commercial Li Name of Building: Lot Mix UseD Other 0 # of Sto es: AKA's: Building Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact: Nam: ' ' Telephone .Number Building Owner Management Activities Interior Survey Performed ❑ Yes Q No Exterior Survey Performed J Yes a No General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes No Locations: Air Monitoring j] Yes No Locations: Copies of All Reports and Data Requested Q Yes

Visual Inspection Results:

Inspected Debris North N/A Yes No No Visible/Fine Layer % to 1 > 1' South N/A Yes No No Visible/Fine Layer '% to 1' > 1' East N/A Yes No No Visible/Fine Layer A to 1' > 1' West N/A Yes No HNoVs1ble/Flne Layer H%tolo > 1' Facade Description: n

Root Debris: No Visible /Fine Layer Q % to 1' Description:

Setbacks N/A]~, Floor___ . Debris: No Visible/Fine Layer % to 1' >1' Floor___ No Visible/Fine Layer 14 to 1' >1' Floor___ Debris: No Visible/Fine Layer A to 1' > 1' Floor___ Debris: No Visible/Fine Layer % to 1' > 1' Floor.____ Debris: No Visible/Fine Layer % to 1' > 1' Comments 4.

Date: 1 /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000115067