WTC building inspection form, 19 Park Place, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Ye Premise Address: ,,,...

Block: Residential D Commercial 0 Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Ow Management: TeIephth4e Number: ( ) Name: `KeaQtU C 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Ye ❑ No ❑ No Visible/Fine Layer ❑%2 1" ❑> 1" South ❑ es ❑ No ❑ No Vislbl a er : to 1" ❑ > 1" East DYesDNo ❑ No Visible/Fine Layer ❑%%tol" ❑>1" West /A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1" Facade Description:

Roof Jy~ Lti . Debris: ❑ No Visible /Fine ' ayer ❑ % to 1" ? ❑ > 1" 1 `;' Description:

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

Comments

Date: /~ 002 Inspection Team: Name: V Agency; i Name:

NYC-WTC-000115967