21 OLIVER STREET Block: 279 Lot: 8 BIN: 1003362 AKA's:

NYC 9/11 Public Portal Document

WTC Visual Survey Form e Premise Address: i <~

Block9 Lot g I Residential j Mix Use 0 Other Commercial Name of Building:

# of St ies: AKA's: Building Owner/Management Telephone Number Name: S 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 Q No Locations: Air Monitoring D Yes 0 No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes j] No No Visible/Fine Layer 0%to1" ❑>1" South N/A Yes [] No No Visible/Fine Layer ❑ 34 to 1" 030-1- East N/A Yes ❑ No No Visible/Fine Layer El%to 1" D>1 West f J N/A Yes,Q No No Visible/Fine Layer 0 14t01 0>? Facade Description: n ()

Roof Debris: No Visible !Fine Layer .j] 3h to V Description:

Setbacks NIA Floor____ . Debris: No Visible/Fine % to 1" 0>1. Floor. LayerH%tolo Debris: No Visible/Fine Layer j] > V Floor Debris: 0 No Visible/Fine Layer 034 to? ❑ > 1" Floor____ Debris: No Visible/Fine Layer 034 to? > 1" Floor.____ Debris: U No Visible/Fine Layer 034 to 1" > H 1" Comments

Date: - 5 I I2CX Inspection Team: Name: Agency N "r Fi Name: Agency_____

NYC-WTC-000116011