WTC Facade Inspection Form, 35 [name]

NYC 9/11 Public Portal Document

f WTC Visual Survey Form . l d 0 (2-73 3-5 A Premise Address: A 0q -/0 Block: Residential 0 Commercial D Name of Building: Lot: Mix Use 0 Other ❑ - — # ofstories: 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 0 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 Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer / to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑.No ❑ No Visible/Fine Layer % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No []No Visible/Fine Layer % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 2 to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer /2 to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: / I4 /2002 Inspection by: Name: Agency: ~ Name: Agency:

NYC-WTC 000116571