WTC building inspection form, 2002

NYC 9/11 Public Portal Document

WTC Visual Survev Form /0010 ire

Prerr, se Address: 112. pL.A c Block: S Residential El Commercial I Name of Building: Lot: Mix Use . Other0 — -- # of Stories: AKA's: Building Owner/Management — 2cMz1 Pj.4- i tu Telephone umber ( cd- - fv, ) 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 Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 'A to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑-No ❑ No Visible/Fine Layer Y2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Y2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer %2 to 1" ❑ > 1" Facade Description:

Roof

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

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: _/ 2002 Inspection by: Name: G Agency: Name: Agency:

NYC-WTC-000116658