WTC building inspection form, 17 Ann Street, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form 10ol Z &O Premise Address: 1 N N S -r REE'T' Block: 90 Residential j Commercial 0 Name of Building: Lot: ,2 Mix Use J Other ❑ # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: 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 Yes

Visual inspection Kesuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A ❑ Yes [] No WNo Visible/Fine Layer ❑ 1/ 2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ 1/ 2 to 1" 0>1" West O N/A ❑ Yes ❑ No • No Visible/Fine Layer ❑ 1/ 2 to 1" ❑>1" Facade Description:

Roof

Debris: 0 No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description: '3 A4 t ELOEA SAK)K)2k Lr t I N%- EN E- P-Ot MI► N 6 PQaSeN1

Setbacks N/A ®, Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" R> 1" Floor: Debris: (J No Visible/Fine Layer ❑ %z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/Z to 1" . ❑ > 1"

Comments

Date: 9//2002 Inspection Team: Name: D A Agency: `> I)ta Name: Agency:

NYC-WTC-000116457