WTC Visual Survey Form, Facade Inspection Results

NYC 9/11 Public Portal Document . .. .. _ . . .. - . .. 4.dw.: _a-sa-.s .'..mss

WTC Visual Survey Form Premise Address: '-~ '►

Block: Residential 0 Commerciaj.KJ I Name of Building: Lot: Mix Use9 Other # of Stories: 2 AKA's: - Building Owner/Management: Telephone Number. ( Name: P rfl4Rk7FAX: Address: On Site. Contact Name: ' Telephone Number. Building Owner Management Activities Interior Survey Performed [j Yes D No Exterior Survey Performed a Yes 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 J Yes

visual Inspection Results: Facade: Inspected Debris North D N/A DYesDNo No Visible/Fine Layer > 1' South ❑ NIA 9YesDNo No Visible/Fine Layer o1' B30 1' East N/A J Yes [] No No Visible/Fine Layer o1' D1 West N/A JYes [j No No Visible/Fine Layer r 14tole 0 l" D > 1' Facade Des ption:

Roof

Debris: D No Visible /Fine Layer ❑ 1/ to 1' 9 , 1' Description:

Setbacks N/A~ Floor: Debris: ❑ No Visible/Fine Layer % to 1 >10 Floor.____ Debris: No Visible/Fine Layer 16 to 1' >10 Floor: Debris: No Visible/Fine Layer % to 1' >10 Floor.__ Debris: No Visible/Fine Layer 1/ to 1' >10 Floor___ Debris: - No Visible/Fine Layer % to 10 >10

Comments

[ te• i4j- / 002 Inspection Team: Name: D. hC R_ !Kell gency OEF D Name: Agency:

NYC-WTC 000117157