WTC visual survey form, Folder 31, Oct 2001

NYC 9/11 Public Portal Document ^VVTC Vjsuat

Survey Form Premise Address;' '.

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Block: Residential 0 CommerciaKJ Name of Building: Lot Mix UseD Other II 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 j;,j Yes No Locations: Copies of All Reports and Data RequestedDYes

visual inspection Kesuits: Facade: Inspected Debris North N/A Yes No No Visible/Fine 36 to 1' a?

South ] N/A Yes No No Visible/Fine Layer 31, to? a?

East N/A Yes No No Visible/Fine Layer 3% to 1' > 1" West N/A Yes No No Visible/Fine-Layer LayerH%tol, > i" Facade Des Lion:

Roof Debris: DNo Visible /Fine Layer n % to 1' r]> 1" Description: NC' GGE"SG

Setbacks N/A, JE Floor.____ Debris: No Visible/Fine Layer 36 to 1' a?

Floor._ Debris: No Visible/Fine Layer 36 to 1 > 1' • Floor__ Debris: No Visible/Fine Layer 34 to 1' al'

Floor.__ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor_ Debris: - No Visible/Fine Layer 34 to 1' > 1'

Comments

Date: . 1 3 32002 Inspection Team: Name: n . R. jK lkAgency DEP Name: Agency: N

NYC-WTC 000117140