111 SOUTH STREET Block: 97 Lot: 31 BIN: 1001326

NYC 9/11 Public Portal Document

4 WTC Visual Survey Form I o ° 13 -2 G PromiseAddress:

Block: 9 7 Resi a fiat 9 Name of Building: Lot 5 Mix Use 0 Other ElLA-4 wAc # of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: dF t G FAX: Address: On Site Contact Name: ' ' Telephone Number. Building Owner Management Activities interior Survey Performed ❑ Yes Q No Exterior Survey Performed a Yes No General Clean Up Yes No Locations: ACM Clean Up ] Yes No Locations: Air Monitoring ❑ Yes 9 No Locations: Copies of All Reports and Data Requested J Yes

Visual inslDection Results: Facade: Inspected Debris North N/A Yes No O No Visible/Fine Layer % to 1' >1" South N/A Yes No No Visible/Fine Layer %tot" >1w East West N/A N/A Facade Description: Yes No 1(es No (~ „ No Visible/Fine Layer No Visible/Fine Layer H to1' %to l" >1" 9>1"

Roof

Debris: 'o Visible /Fine Layer 934 to 1" 9>1" Description:

Setbacks N/A Floor Debris: No Visible/Fine Layer 36 to 1' >1" Floor____ Debris: No Visible/Fine Layer 34 to 1" >1" Floor.__ Debris: No Visible/Fine Layer % to 1' >1" Floor____ Debris: No Visible/Fine Layer Va to 1' >1" Floor Debris: No Visible/Fine Layer 34 to 1' >1"

Comments

Date: / IAO/2002 Inspection Team: Name: Agency: - ENTEREO Name: Agency:

NYC-WTC-000116870