WTC facade inspection form, 109 South Street, 2001

NYC 9/11 Public Portal Document

• ' ► 1, WTC Visual Survey Form Premise Address: Block: Residential Commercial J , Name of Building: Lot: Mix UseD Other # o Stories: AKA's: Building OwnerIM a ment: Telephone Number. ( ) Name: FAX: Address: On Site Contact Name: Telephone Number n Building Owner Management Activities Interior Survey Performed Yes Q No Exterior Survey Performed Yes No General Clean Up Yes No Locations: ACM Clean Up • Yes No Locations: Air Monitoring Yes 0 No Locations: Copies of All Reports and Data Requested DYes

Visual inspection Results: Facade: Inspected Debris North N/A Yes No O No Visible/Fine Layer ❑%toll 9>1 0 South N/A Yes No No Visible/Fine Layer [] % to l' > 1" East West DNFA N/A Facade Description: /1 Yes No as No ,, _ No Visible/Fine Layer No Visible/Fine Layer 934t0 36 to 1 , 9' > 'i• > 1'

Roof Debris: Z~1QoVisible /Fine Layer j] % to i 9>1' Description.

Setbacks N/A Floor Debris: No Visible/Fine Layer 934 to 1' Floor. Debris: No Visible/Fine Layer % to 1' Floor:____ Debris: No Visible/Fine Layer 34 to 1' Floor:___ Debris: No Visible/Fine Layer 36 to 1' Floor. Debris: No Visible/Fine Layer 34 to V Comments

Date: /, 00'1 Inspection Team: Name: Name: NT ER

NYC-WTC 000116861