License agreement for facade cleanup, 22 Thames St, Oct 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Addres s

Block: Residential 0 Commercial Name of Building: Lot: Mix Use ❑ Other # of Stories: AKA's: Building Owner/M na ement: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: fi Name: L Telephone Number: (moo -t,) 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 ❑ Yes

Visual Inspection Results: Facade: Inspected D brie North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/% to 1" ❑ > 1" South ❑ N/A ❑ Yes Q No I No Visible/Fine Layer ❑ Y% to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No NoVisibleIFine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: o Visita /F'ne La er ❑ % to 1" ` 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %z to 1" ❑ > 1" Floor: Debris: Q No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: ii /2002 Inspection Team: Name: Agency: Name: Agency:

' ATE NYC-WTC-000116119