WTC visual inspection form, 104 Trinity Place, May 2002

NYC 9/11 Public Portal Document

) '4 Tri n ( i PI WTC Visual Survey Form Premise Address: o 1 r c V

Block: Resi tial Commercial J Name of Building: , \-JL-ek Lot: Mix Use D 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 D Yes

Visual Inspection Results: Facade: Inspected Debris North NJA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1" South ❑ N/A E3-Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ` 1" East ❑ N/A JaYes 0 No ❑ No Visible/Fine Layer ❑ % to 1" 1" West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

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

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

Comments

Date: ~/ Z ~ /2002 Inspection Team: Name: (ip"z¼- L4 ((C Agency: 2 T " Name: Agency:

NYC-WTC 000116590