12 OLIVER STREET Block: 279 Lot: 69 BIN: 1003388 AKA's: 3 Henry Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Pre~'iae 4iddress:

Block: ResidentialD Comme al Name of Building: Lot Mix UseIJ Other # of Stories: AKA's: o Buildin Owner/Management: Telephone Number ( ) Name: w- Addres : On Site Co • Name: ' " C9-, Telephone Number. Building Owner Management Activities Interio Survey Performed ❑ Yes No Exteri r Survey Performed Yes No GenerBi Clean Up ❑ Yes No Locations: ACM lean Up a Yes No Locations: Air M nitoring D Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results:

Inspected Debris North ❑ NIA ❑ Yes No No Visible/Fine Layer 034to1' r]>1' So N/A Yes No No Visible/Fine Layer ❑ 34 to 1' [] >1. East N/A Yes No No Visible/Fine Layer ❑ y4 to 1' 9>1' Wes N/A Yes No No Visible/Fine Layer '/s to 1' 0>1' Facade~escrlption: (1

Roof Debris: Visible /Fine Layer .934 to 1' 9>1' Description: qqo

Setbacks N/At( Floor.___ Debris: No Visible/Fine Layer 34 to 1' '1' Floor. Debris: No Visible/Fine Layer % to 1' 'l' Floor____ Debris: No Visible/Fine Layer h to 1' >1' Floor____ Debris: Q No Visible/Fine Layer h to 1' >1' Floor __ Debris: a No Visible/Fine Layer h to V >1'

Comments

Date: b/ 12002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000116029