WTC building inspection form, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: i S a SI Block: Residential D Commercial J Name of Building: Lot: Mix UseD 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 0 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 ❑ 34 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Vsible/Fine Layer ❑ Y2 to 1' 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ a to 1" ❑ > 1" Facade Description: 9 ( i LL.. 1) r Y rc cl

Roof

Debris: I sible /Fine Layer ❑ 34 to 1" ❑ > 1" Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ 34 to 1' 0>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" [J> 1" Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ y4 to 1' ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ y4 to 1" ❑ > 1"

Comments

Date Datesfl7 I C 0 Inspection Team: Name: Agency: Name: C -~ Agency:

NYC-WTC 000116685