WTC visual survey form, BIN 1805207, Oct 2001

NYC 9/11 Public Portal Document WTCVisual Survey Form Premise Address: Block: Residential Commercia Name of Building: Lot: Mix UseD OtherlJ S of Stories: 2. AKA's: Building Owner/Management Telephone Number ( ) Name: k 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 fl Yes Visual Inspection Resuns: Facade: Inspected Debris North N/A YesHNo No Visible/Fine Layer % to 1' fl , ? South N/A Yes No No Visible/Fine Layer %tot >1' East N/A Yes No No Visible/Fine Layer >1' West N/A Facade Description: Yes No No Visible/Fine Layer H34tol' °1' >1'

Roof Debris: 0 No Visible /Fine Layer j] % to 1' D > 1' Description: D 1G~

Setbacks N/A, Floor. Debris: No Visible/Fine Layer 34 to 1' > 1' Floor Debris: No Visible/Fine Layer % to? > 1' Floor____ Debris: No Visible/Fine Layer % to 1' > 1' Floor: Debris: No ViVisible/Fine Layer 34to to? > 1' Floor____ Debris: - No Visible/Fine Layer 34 to 1' > 1' Comments

Date: 4/2712002 Inspection Team: Name: T~. The _ R. 6VelI gency: E Name: Agency:

eNTEREO

NYC-WTC 000117136