WTC building inspection form, 17 Ann Street, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual ... . a Form (OOlZ1I Premise`Address'

Block qp Residential 17 AwN Commercial J Sier

Name of Building: Lot 23 Mix Use p Other - # of StolIes. AKA's; Building Owner/Management Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: Telephone Number. -Building Owner Management Activities Interior:SUrvey Performed ❑ Yes 0 No Exterior Survey Performed ❑ Yes ❑ No General--Clean Up 0 Yes [] No Locations: ACM man Up 0 Yes ❑ No Locations: Air Monitoring ❑ Yes [1No Locations. Copies of All Reports and Data Requested J Yes

X/Isual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer [IJYato 1" 0>1" South ❑N/A ` ❑ Yes ❑ No ❑ No Vsible/Fine Layer % to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" D>1 West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Y to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑Y to 1" 0>1" Description:

Setbacks N/A Floor: Debris: 0 No Visible/Fine Layer ❑'/ to1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ !2 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 ❑ 34 to 1" ❑ > 1" Comments

II'p Ac'9iT Date: t/J412002 Inspection by: Name: Name: _ Agency:- Agency

000116448 NYC-WTC