WTC building inspection form, 21 Park Place, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form 4 Premise Address: tC 2- /nA-( Block: Lot: # of Stories: $" AKA's: Residential 0 MixUseD Commercial j J OtherD Name of Bui din : /tl" Xi%- 2Cl-& '

Building Owner/Management: Telephone Number: Name: Z 1 /Q7Z.i P6i-i: /€ 1-/ c. FAX: Address: 2,,j Ivy , On Site Con ct: Name: " * rrt t e - c,..,ee Telephone Number: 212, — 176 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 0 Yes

Visual Inspection Results: Facade: Inspected Debris North ®N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1' South ❑ N/A ® Yes ❑ No ® No Visible ne La ❑ V2 to 1" ❑ > 1" pt East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine ayer ❑ % to 1" ❑ > 1" 4d West f N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1" Facade Description: /' /

Roof u

Debris: ❑ No Visible /Fine layer M'/ to 1" 9 0>1" Description:

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

Comments 5t41/4, dr .

Date: 1 / a1 /2002 Inspection Team: Name: Agency: as

I Name: Agency: E

RF-r9 NYC-WTC-000115946