WTC facade inspection form, [name] Avenue

NYC 9/11 Public Portal Document

ONO WTC Visual Survey Form Premise Address: 1Jat ow•!~ ~~' ` ~.. Div o~ U~1 W ..- ~/ Block: I Residential p Corn ercia{ Xj Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Ow a /M na err~ent: (i; telephone Number. (7i1 .$a- 3 ti c{ Name: 1 LA u g0LU o1A e_ AX: Address: On Site Co lac t Name: - - ~ " t 2 ,-- t V0 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 j Yes

Visual Inspection Results: Facade: /'t '1 Inspected Debris North ❑ N/A [] Yes ❑ No ❑ No Visible/Fine Layer ❑Vato 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yato1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Vto1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yatol" 0>1" Facade Description:

Roof - (

Debris: ❑ No Visible /Fine Layer ❑'%tol" 0>1" Description:

Setbacks N/AX Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer 034 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" 0> 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ a to 1" 0> 1" Comments . y ~ -

Date: Inspection Team: Name: `'' " Agencyfyc-1 Name: Agency:

S NYC-WTC-000116048