WTC building inspection form, 2002

NYC 9/11 Public Portal Document

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• WTC Visual Survey Form 10000if I Premise Address: s ©•% 2 S Block: i $ Residential 0 Commercial 0 Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: /y~ ~• Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑Yes 0 No Exterior Survey Performed 0 Yes 0 No General Clean Up Yes No Locations: ACM Clean Up Yes No Locations: Air Monitoring 0 Yes 0 No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A [ 'Yes 0 No 9 No Visible/Fine Layer ❑ 14 to 1' > 1" South N/A ❑ Yes 0 No No Vsible/Fine Layer 14 to 1" 0>10 East EN/A ❑ Yes 0 No DNoVisiblelFineLayer DYatoV 0>? West ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer 014 to 1" ❑ > 1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ i4 to? ❑ > 1" Description:

Setbacks N/A 0 Floor. Debris: 0 No Visible/Fine Layer ❑ 14 to 1' ❑ > 1' Floor. Debris: 0 No Visible/Fine Layer I] % to 1" ❑ > 1' Floor: Debris: 0 No Visible/Fine Layer ❑ 14 to 1' ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ 14 to 1' 9> 1' Floor. Debris: 0 No Visible/Fine Layer ❑ 14 to 1' 0 > 1'

Comments

Date: 7 1 11-12002 Inspection Team: Name: Agency: Name: Agency: ______ ENTERED

NYC-WTC- 000116681