WTC visual inspection form, 104 Trinity Place, May 2002

NYC 9/11 Public Portal Document WTC Visual Survey Form Premise Address: /o 1-ii Iy p c26e Block: Residential 0 CommercialD Name of Building: Lot: Mix Use l Other N of Stories: AKA's: /09 Ce syk Building OwnerlManagement: Telephone Number: (2/Z) 273 6S 2 Name: N,c4 rflxfrears n4r, cue f! LG . 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 Results: Facade: Inspected Debris North N/A , `Yes ❑ No ❑ No Visible/Fine Layer ❑ 4to1" ❑>1" South N/A J 'Yes ❑ No ❑ No Visible/Fine Layer %: to 1' 0>1 0 East ❑ N/A B Yes ❑ No ❑ No Visible/Fine Layer '%stol' 0>1 0 West 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑vato1" 0>1" Facade Description:

Roof

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

Setbacks N/Az Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1' Floor. Debris: 0 No Visible/Fine Layer ❑'A to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑'A to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ i4 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1' ❑ > 1'

I Comments ' I

Date: 7 / 12002 Inspection Team: Name: tf,9/ Agency: M/t p Name: Agency: 4 NTERE'

NYC-WTC 000116589