WTC Facade Inspection Form, 19A [location]

NYC 9/11 Public Portal Document Visual Survey Form Premise Add : •'

Block: Residential Co' JercipPçJ Name of Building: Lot: Mix Use 9 Other J J # of Stories: AKA's: f , 2p'l~ r . Building Owner/Management Telephone Number ( Name: FAX: Address: - On Site Contact Name: • ' 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 j_] No Locations: Copies of All Reports and Data Requested p Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑ % to 1' 0>1' South East West ❑ N/A ❑ N/A J N1A ❑ Yes ❑ No ❑ Yes ❑ No jo Yes ❑ No No Visible/Fine Layer No Visible/Fine Layer % to 1' 0>1' Tito l' No Visible/Fin -Layer ❑%to1' ❑>1' '0>1 Facade Des Lion:

Roof

Debris: [] No Visible /Fine Layer ❑'/ to V 0>1' Description: A E

Setbacks WA' Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1' > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1' >1. Floor. Debris: No Visible/Fine Layer ❑ % to 1' > 1' Floor. Floor:___ Debris: 0 No Visible/Fine Layer Debris: 0 No Visible/Fine Layer 034 'h to 1' to 1' ❑ > 1' 0>1'

Comments

Date: _ . I a _112002 Inspection Team: Name: .L' • " ' • "''C °`Rgency: '"' r ' Name: Agency:

NTE RE ~

NYC-WTC 000117226