WTC building facade inspection form

NYC 9/11 Public Portal Document 'G -sow ......a - r.a_' -- '- ---'9a---------- -

WTC Visual Survey Form Premise Addresr 6~ Block: Residen HCot rciajKJ Name of Building: Lot Mix UseD Other # of Stori s: 2 AKA's: Building Owner/Management Telephone Number ( ) Name: fu c FAX: Address: On Site C ntact* Name: ' ' Telephone Number. BuildingOwner Management Activities Interior Survey Performed Yes[] No Exterior Survey Performed Yes 0 No General plean Up Yes No Locations: ACM C an Up Yes No Locations: Air Monitoring 9 Yes o No Locations: Copies of All Reports and Data Requested J Yes Visual Insbection Results: Facade: Inspected Debris North 9 N/A Yes No No Visible/Fine Layer 14 to 1' >1' South J J N/A Yes No No Visible/Fine Layer A to 1' >1' East 9 N/A Yes 0 No No Visible/Fine Layer % to 1' >1' H:01N West N/A gYesoNo No Visible/Fine Layer 914 to 1' Facade Des ption:

Roof Debris: ❑ No Visible /Fine Layer 9 % to l' 9>1' Description:

Setbacks N/A~ Floor Debris: No Visible/Fine Layer 1 to 1' >1' F r Debris: No Visible/Fine Layer 14 to? >1' F r. Debris: No Visible/Fine Layer 14 to 1' > 1' F r. Debris: No Visible/Fine Layer % to l' >1' Floor Debris: No Visible/Fine Layer % to 1" > 1' Comments

A Date: 41,12002 Inspection Team: Name: f. S1G R_ iQKP 11 gency DEF Name: Agency:

NYC-WTC- 000117161