WTC Visual Survey Form, 119 South Street, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form /0 () `30~ Premise Address: ~ $,.._ "'H ~EE1 Bock: Residential U CommercialI I Name of Building: Lot Mix Use 0 Qther AKA's: I I q #of Stories: Building Owner an em nt Name: / I i7 I i 6 . r)u4c o-, / Telephone uttber ( 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 Report. and Data Requested pYes

Visual lnsoectlon Results: Facade: Inspected Debris North N/A Yes No No Visible/Fine Layer % to 1' > 1' South N/A Yes No No Visible/Fine Layer 4 to 1' > 1' East N/A Yes No No Visible/Fine Layer % to V > 1' West N/A Yes No r4p Visible/Fine Layer % to 1' > 1' Facade Description: n -

Roof Debris: ' No Visible /Fine Layer .Q% to 1' L] > 1' Description:

Setbacks wAEJ- Floor:_ . Debris: No Visible/Fine Layer Ne to V 0> 1' Floor:___ Debris: No Visible/Fine Layer i4 to 1' > 1' Floor___ Debris: No Visible/Fine Layer 34 to 1' '1' Floor____ . Debris: No Visible/Fine Layer )4 to 1' > 1' Floor____ Debris: No Visible/Fine Layer ,4 to 1' > 1' Comments

Date: 1 Inspection Team: Name: It "(, Agency: Name Agency:

NYC-WTC 000116886