DEP letter requesting environmental data for 21 South End Ave,

NYC 9/11 Public Portal Document

s.y rr WTC Visual Survey Form - '4 mise Address: ,•,~

Block: Resident! Commercial J J Name of Building: Lot: '7 5o7 Mix Use L3 Other # of Stores: AKA's: Building Own anagem t• jO hone Nut PII U Name: 0~ r Y AX: PII Address: -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-...- On Site Contact: Name: * ' ~~<) -- Telephone Number: Building Owner Management Acti4iltles Interior Survey Performed [,Yes ❑ No Exterior Survey Performed 'es ❑ No C General Clean Up j les Q No Locations: J ACM Clean Up Q Yes Flo Locations: Air Monitoring ces Q No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: In ected Debris

t North ❑ N/A fJ Yes ❑ No No Visible/Fine Layer QY2to1" Q>1" South Q N/A YesDNo o Visible/Fine Layer Q%to1" ❑>1" East ❑ N/A YesDNo o Visible/Fine Layer ❑ % to 1" 0>1" West ❑ NIA aYes Q No o Visible/Fine Layer QYato 1" 0>1" Facade Description:

Roof

Debris: 5No Visible /Fine Layer 0% to 1" ❑ > 1"

Setbacks Floor: • Debris: Q No Visible/Fine Layer ❑ Ya to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑'% to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Comments \ b ~"`'

Date: ! "8'/2002 Inspection Team: Name: A Name: Agency:

NYC-WTC 000117322