WTC building inspection form, 34 Park Row, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 12 S'4 Premise Address: 1

Block: 4O Residential 0 Commercial D Name of Building: Lot: Mix UseD Other # of Stories: AKA's: 3Cf YO.r Building Owner/Management: Telephone Number. ( ) Name: FAX:( ) Address: On Site Contact Name: tin 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: PevJ€ E'\A ~ch & Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested s !v Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑Yes ❑ No ❑ No Visibl ine Layer '% to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No 0 No Visible/Fin er ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to l" [J> 1" Facade Description: % . -

Roof

Debris: ❑ No Visible /Fine Layer 2 to 1" ❑ > 1" Description: JV . /1rtliJ. u4tQlet A3

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" 0>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Comments

Date: Inspection by: Name: t.. 1.., Agency: Name: Agency:

NYC-WTC- 000115434