WTC Facade Inspection Form, 18-19 [location]

NYC 9/11 Public Portal Document

WTC Visual Survev Form l $0 Sl Premise Address: Block: Residential 0 Commercia Name of Building: Lot MixUseD Other # of Stories: AKA's: Building Owner/Management Telephone Number ( ) Name: FAX: Address: On Site Contact Namd: ' ' '' Telephone Number Building Owner Management Activities Interior Survey Performed Yes 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 Inspection Results: Facade: Inspected Debris North NIA Yes ❑ No No Visible/Fine 34 to 1 >1' South N/A Yes[[]] No No Visible/Fine Layer % to 1' >V East N/A Yes No No Visible/Fine Layer 34 to 1' > 1' West N/A Yes No No Visible/Fine Layer LayerH%1016 > 1' Facade Description: n C) „ _0

Roof Debris: I No Visible /Fine Layer 934to1' Q>1% Description:

Setbacks NIA Floor___ Debris: No Visible/Fine Layer % to 1' >V 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: No Visible/Fine Layer % to 1' > 1' Comments

Date: =/ Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000117218