Asbestos bulk analysis chain of custody form for 250 South

NYC 9/11 Public Portal Document WTC Visual Survey Form Premise Address: t

Block: Residential Commercial 0 Name of Building: Lot: Mix Use J Other # of Stories: I AKA's: Building Owner/Mans ement Telephone Number. Name: FAX: Address: On Site Contact: Name: l. e rseo Telephone Number. PII Building Owner Management Activities .. ..--........................................................... Interior Survey Performed [ Yes ❑ No Exterior Survey Performed 0 Yes ❑ No General Clean Up ❑'Yes ❑ No Locations: ACM Clean Up ❑ Yes Q'No Locations: Air Monitoring Q'Yes ❑ No Locations: Copies of All Reports and Data Requested EYes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Q'Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" South ❑ N/A EYes ❑ No ❑ No Visible/Fine Layer DYatol 0>1 East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑/~ to 1"w 0>10w West ❑ N/A mYes ❑ No ❑ No Visible/Fine Layer ❑'/a to 1" 0>1" Facade Description•

Roof

Debris: No Visible /Fine ayer 0 % to 10.1 ❑ > 1" / •{ "'t Description:

Setbacks N/A s Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1' ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/i to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %a to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1" Comments

Date: ,~/ Z~/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000117400