WTC Facade Inspection Form, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ~ 'C'

Block: Residential 5"HCor rcia J Name of Building: Lot Mix UseD Other # of Stories: 2.. AKA's: Building Owner/Management Telephone Number ( ) Name: W c FAX: Address: On Site Contact Name: ' ' Telephone Number. Building Owner Management Activities Interior Survey PerformedHYesoNo Exterior Survey Performed Yes L] No General Clean Up Yes No Locations: ACM Clean Up Yes No Locations: Air Monitoring 0 Yes 9 No 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 ] N/A YesD No No Visible/Fine Layer /1 to 1' > 1' East O N/A gYOSONO No Visible/Fine Layer %to10 >1' West NIA 1Yes ❑❑ No No Visible/Fine Layer h to 1' >1' Facade Desdiption:

Roof

Debris: j]No Visible /Fine Layer ❑ % to? 9> 1' Description:

Setbacks N/A M Floor.____ Debris: No Vmsible/Fine Layer % to 1' > 1' Floor. Debris: No Visible/Fine Layer 34 to 1' > 1' Floor. Debris: No Visible/Fine Layer 34 to 1' > 1' Floor. Debris: No Visible/Fine Layer 34 to 1' > 1' Floor. Debris: D No Visible/Fine Layer 36th? >1 Comments

Date: 4- i2.7 12002 inspection Team: Name: T).19hc R. 4keIkAgency: OEP Name: Agency:

NYC-WTC 000117177