Visual inspection results, 21 [address], BIN 1805171

NYC 9/11 Public Portal Document

fri WTC Survev Form Premise Address: Block: Residential 0 Commercial Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Buliding Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact Namd: ' ' '. Telephone .Number. Building Owner Management Activities Interior Survey Performed Yes Q 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 Yes Visual InsDection Results: Facade: inspected Debris North NIA Yes No No Visible/Fine Layer S4 to 1' a 1' South N/A Yes No No Visible/Fine Layer % to 1' aV East N/A Yes No No Visible/Fine Layer % to 1' > 1' West N/A Yes No No Visible/Fine Layer % to 1' > 1' Facade Description: f 1

Roof Debris: '(No Visible IFine Layer .❑ % to 1' j] s 1• Description:

Setbacks N/A EI Floor:___ Debris: No Vllsible/Flne Layer 34 th? a? Floor:___ Debris: No Visible/Fine Layer % to? s 1' Floor___ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor____ Debris: No Visible/Fine Layer % to V a 1' Floor___ Debris: No Visibie/Fine Layer 34th? >1 i Comments

Date: ... J_1412002 inspection Team: Name: ' ^~ Agency:.______ Name: Agency:

NYC-WTC-000117150