211 PEARL STREET 1001120, 69/6

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 l ` Zo Premise Address:

Block: Residential 0 Commercial J Name of Building: Lot: Mix Use J Other jJ # of ories: 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 ❑ 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 J I Yes

visual inspection Kesults: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/a to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to l" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %a to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %a to 1" 0>1" Facade Description:

Roof t~.~i b ol$-fo%is• ,, s Debris: /Fine Layer ❑%to l" 0>1" Description: l vt Si:'ec- B

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑V 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"

Date: Z / 002 Inspection Team: Name: 1 Agency: 1F0 Name: Agency:

NYC-WTC-000115358