WTC visual survey form, Block 73, Oct 2001

NYC 9/11 Public Portal Document WTC Visual urvey Form Premise Address: 1 a %,'/ Block:')'Jf Residential CommercialJ Name of Building: Lot: 0 Mix Use 0Other # of Stories: AKA's: 3, 5'6re~ ------------------------------------------------------- Building Owner/Management: Telephone Number. P II Name: FAX: Address: On Site Contact: .4 . Name: - Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes 0 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 D Yes

Visual insuection Results: Facade: Inspected Debris North N/A Yes ❑ No No Visible/Fir o LayE D34to1" 0>1" South N/A ~Yeso!Slo O Visible/Fine Layer No %to1" a>1" East ❑ N/A ❑ Yes Q No 0 No Visible/Fine Layer ❑hto1" ❑>1" West )J N/A ,( 'Yes ❑ No JZNo VisibleIFin ryes Q % to 1" F]: ,. 1 " Facade Description:

Debris: 0 No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description:

Setbacks N/Am Floor Debris: ❑ No Visible/Fine Layer ❑ h to 1' 0>1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" 0>1" Floor. Debris: No Visible/Fine Layer ❑ h to 1' 0>1" Floor. Debris: No Visible/Fine Layer [] h to 1" >1" Floor: Debris: 0 No Visible/Fine Layer 934 to 1" H.*0 1"

Comments lUrte ,4! —4,ll~.t— j.

, Date: 4,_/,_/2002 inspection Team: Name: , ,4( ;,l ~ .braS gency: Q - • Name: Agency: ENTERED

NYC-WTC 000117117