15 OLIVER STREET Block: 279 Lot: 11 BIN: 1003365 AKA's:

NYC 9/11 Public Portal Document

I✓ WTC Visual Survey Form /0 33&.S Premise Address: t Block: 27 Residential Commercial J Name of Building: Lot: i Mix Use 9 Other #ofSbrl 3 AKA's: Building OwnerlManagerppnt S Telephone Number ( ) Name: FAX: Address: 0 -- (QLfcf On Site Contact: Name: ' ' Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes Q No Exterior Survey Performed Yes No General Clean Up 0 Yes 0 No Locations: ACM Clean Up ❑ Yes Q No Locations: Air Monitoring D Yes Q No Locations: Copies of All Reports and Data Requested D Yes

Visual inspection Results: Facade: Inspected Debris North [j N/A DYesDNo O No Visible/Fine Layer South ❑ N/A Yes No No Visible/Fine Layer D % to l" Q 1" East [] N/A Yes No No Visible/Fine Layer %to 1" 0>1" West [J N/A ❑ Yes 9No Nq Visible/Fine Layer %toll []>1" Facade Description: t AM

Roof Debris: ~No Visible /Fine Layer .0 % to 1" ❑ > 1" Description:

Setbacks N/As Floor___ Debris: Q No Visible/Fine Layer ❑ % to? 0>1. Floor____ No Visible/Fine Layer % to V 0>1" Floor____ Debris: No Visible/Fine Layer ❑ % to 1" 0>1" Floor Debris:_} No Visible/Fine Layer ❑ % to V >1' Floor.____ Debris: [j No Visible/Fine Layer ❑ % to 1' 8301"

Comments

j_,1_12002 Inspection Team: Name: Agency: Name: Agency: N T E RE0

NYC-WTC 000116035