WTC visual inspection form, 104 Trinity Place, May 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ' 11 A Block: Residential 0 CommercialD Name of Building: Lot: Mix Use f J Other J ` # of Stories: AKA's: ot.(. 1 Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: o 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: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to V 0>1" East ❑ N/A 9es ❑ No No Visible/Fine Layer E)Y2 to 1" 0>1" West ❑ N/A EYesDNo ❑ No Visible/Fine Layer ❑ 1/ to 1" 0>1" Facade Description:

Roof

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

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments

Date: V /r 0 /2002 Inspection Team: Name: y ' ► Agency: Name: Agency:

NYC-WTC- 000116588