112 SOUTH STREET Block: 97 Lot: 4 BIN: 1001325

NYC 9/11 Public Portal Document

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wTC Visual Surve Form Premise Address: ~ ~~~~ i Block: Residential D Commercial Name of Building: Lot: U Mix UselJ OtherEl # of Sto s: AKA's: Building Owner/M a ement 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 No Locations: ACM Clean Up Yes No Locations: Air Monitoring [J Yes D No Locations: Copies of All Reports and Data Requested jj Yes

Visual lnscection Results: Facade: • inspected Debris North N/A ❑ Yes No 9 No Visible/Fine Layer % to 1' > 1" South N/A Yes No No Visible/Fine Layer 34 to 1' > 1' East N/A Yes No No Visible/Fine Layer % to 1' >1' • West N/A Yes No No Visibie/Fine Layer 36 to 1 D 1' • Facade Description:

Roof Debris: toVisible /Fine Layer r] % to 1' D > 1' Description:

Setbacks N/ Floor: Debris: No Visible/Fine Layer ❑ % to 1' > 1' Floor. Debris: No Visible/Fine Layer % to 1" > 1' Floor: Debris: No Visible/Fine Layer % to 1' >1 Floor. Debris: No Visible/Fine Layer 36 to 1' >1' Floor. Debris: No Visible/Fine Layer 34 to 1' > 1'

Comments

_I ___ I Date: 1442002 inspection Team: Name: Agency: Name: Agency:_ ENTERED .

NYC-WTC 000116878