113 SOUTH STREET Block: 97 Lot: 3 BIN: 1001324

NYC 9/11 Public Portal Document

114

WTC Visual Survey Form Premise Address: 'i' Block: Residential Commercial Name of Building: Lot Mix UseD Other #! of Stories: AKA's: Building OwnerIMaragement Telephone Number. ( ) Name: C 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 No Locations: ACM Clean Up Yes No Locations: Air Monitoring Yes[] No Locations: Copies of All Reports and Data Requested Yes Visual InsDection Results: Facade: Inspected Debris

H North N/A Yes (] No No Visible/Fine Layer 34 to 1' 9>1' South N/A Yes [] No No Visible/Fine Layer A to l' 0>1' > w East N/A Yes Q No No Visible/Fine Layer '~2 to 1 0 1 West N/A Yes [] No No Visible/Fine Layer %tol" >1' Facade Description: /) (}

Roof Debris: No Visible /Fine Layer ❑ 34 to 1' 9>1' Description:

Setbacks N/A Floor. Debris: t] No Visible/Fine Layer % to 1' > 1' floor. Debris: j] No Visible/Fine Layer 34 to 1' >1' Floor. Debris: j] No Visible/Fine Layer % to 1' > 1' Floor. Debris: Q No Visible/Fine Layer % to 1' > 1' Floor___ Debris: No Visible/Fine Layer % to 1' > 1' Comments

• Date: i 1 2OO2 Inspection Team: Name ` Agency. Name: Agency:__________ ENTERED

NYC-WTC-000116874