WTC interior and facade inspection form

NYC 9/11 Public Portal Document WTC Visual Survey-Form Premise Address: Block: Residential Commercial Name of Building: Lot: Mix usefJ Other # of Stories: AKA's: Building Owner/Management Telephone Number ( Name: kNye— r r F rn4RkrFAX: Address: On Site Contact: Name: ' ' Telephone Number. Building Owner Management Activities interior Survey Performed ❑ YesD No Exterior Survey Performed Yes No a

General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes No Locations: Air Monitoring Yes Q No rj

Locations: Copies of All Reports and Data Requested J Yes

Visual insuection Results: Facade: Inspected Debris North ❑ N/A Yes No No Visible/Fine Layer % to 1' ❑ > 1' South a

N/A Yes No No Visible/Fine Layer '%stol* 0>1* East N/A Yes No No Visible/Fine Layer 3% to 1' J>1 0 West j N/A Yes No No Visible/Fins Layer %to l* 9>1k Facade Des pbon:

Roof

Debris: 0 No Visible /Fine Layer 034 to 1' 9>10 Description: NO _GESQ

Setbacks N/AJZI Floor___ Debris: No Visible/Fine Layer % to 1 0 >10 Floor____ Debris: No Visible/Fine Layer 34 to 1 >10 Floor. Debris: No Visible/Fine Layer 3% to 1* >10 Floor Debris: No Visible/Fine Layer 36 to 1' > 1* Floor. Debris: No Visible/Fine Layer 36 to 1 0 >10

Comments

Date: 12212002 Inspection Team: Name: D . a4, R. lcAoency: OEP N T EREO Name: Agency:

NYC-WTC 000117166