WTC visual survey form, Folder 21, Oct 2001

NYC 9/11 Public Portal Document C.Visual Surve , Form t Premise Address: Block: Residen HCor Lèia(i.J Name of Building: Lot: Mix Use J Other # 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 Q No Exterior Survey Performed [] Yes a No General Clean Up Yes No Locations: ACM Clean Up Yes No Locations: Air Monitoring D Yes No Locations: Copies of All Reports and Data Requested fl Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Yes No No Visible/Fine % 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 34 to 1" '1' West N/A Yes No ,~ No Visible/Fine-Layer LayerH%tol" > 1' Facade Des ption:

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1' 0>1' Description: NO RCE

Setbacks N/A, Floor____ Debris: No Visible/Fine Layer % to 1' >1' Floor____ Debris: No Visible/Fine Layer 34 to 1" >1' Floor____ Debris: No Visible/Fine Layer % to 1' >1' Floor Debris: No Visible/Fine Layer 3/ to 1' ❑ >1' Floor___ Debris: - No Visible/Fine Layer % to 1' ❑ > 1" Comments

Date: 4/x/2002 Inspection Team: Name: n . S1'1C4, f e lkAgency DEP Name: Agency: 0.

NYC-WTC 000117148