WTC facade inspection form, 17 State Street, 2001

NYC 9/11 Public Portal Document

ii WTC Visual Survey Form remise Address: ~— s r i Block: R sidentiaiEl CommercialEl Name of Building: Lot: Mix Usefl Other # of Stories: AKA's: Building Ow er/Managem ( & PonePumber ( ) Name• ® ~C.V 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 9 No Locations: ACM Clean Up ❑ Yes 9 No Locations: Air Monitoring ❑ Yes 0 No Locations: Copies of All Reports and Data Requested p Yes

Visual Insoection Results: Facade: Inspected Debris North ❑ N/A 0 Yes ❑ No 0.No Visible/Fine Layer ❑ % to 1" 0>1" South 0 N/A ❑Yes ❑ No 9 No Visible/Fine Layer ❑ h to 1" 0>1" East ❑ N/A 9 Yes 0 No 0 No Visible/Fine Layer ❑ % to 1" 0>1" > 1" West ❑ N/A Yes 9 N ❑ No Visible/Fine Layer [] % to 1" 9>1" Facade Description: c Roof

Debris: RVoVisible /Fine Layer ❑ 14 to 1" 0>1" Description:

Setbacks N/I4 Floor Debris: ❑ No Visible/Fine Layer D % to 1" > 1" Floor Debris: Q No Visible/Fine Layer ❑ 3 to 1" > I" Floor. Debris: No Visible/Fine Layer 34 to I" > I" Floor.____ Debris: 0 No Visible/Fine Layer Y to 1" > I" Floor. Debris: ❑ No Visible/Fine Layer 34 to 1" > 1" Comments

Date: inspection Team: Name: - Agency: Name: Agency: ENTERED

NYC-WTC-000116796