17 OLIVER STREET Block: 279 Lot: 10 BIN: 1003364 AKA's:

NYC 9/11 Public Portal Document

WTC Visual Survey Form ,I t r)? LI Premise Address: 1 t J C^..~2_ S Block: Residential J Commercial Name of Building: Lot Mix UseD OtherD # of Stories: AKA's: Building Owner/Man a ent: Telephone Number. ( ) Name: YV¼i FAX: Address: - On Site" Co tact: 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 0 Yes

Visual tnsoection Results: Facade: Inspected Debris North ❑N/A DYesDNo 0 No Visible/Fine Layer []#to 1' > 1' South ❑ N/A Yes =] No No Visible/Fine Layer %to1' B20 1' East ❑ N/A DYesDNo No Visible/Fine Layer ❑ 4 to 1' ❑ > 1' West [] N/A Yes No ❑ No Visible/Fine Layer 2to1' 0>1' Facade Description: (~

Roof

Debris: No Visible !Fine Layer .914 to 1' 0>1' Description:

Setbacks N/A jj Floor____ Debris: 0 No Visible/Fine Layer 14 to V 9>1' Floor____ Debris: Q No Visible/Fine Layer % to 1' 9>1' Floor_„__ Debris: No Visible/Fine Layer % to V >1' Floor____ Debris: 0 No Visible/Fine Layer % to V >1' Floor____ Debris: 0 No Visible/Fine Layer 14 to 1' >1'

Comments

Inspection Team: Name: Agency: Name: Agency: ENTERED

NYC-WTC-000116026