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NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: '[ ,w/

l •G 1 Block: Residential Commercial J Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Owner/Mane ement: Name: 9 Telephone Number: ( ) I FAX: Address: On Site Contact: Name: k4 1 c Telephone Number: ( -2e 2) 1— Building Owner Management Activities Interior Survey Performed ["Yes ❑ No Exterior Survey Performed Q Yes ❑ No General Clean Up D'Yes ❑ No Locations: ACM Clean Up ❑ Yes ['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 j3Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" South ❑ N/A ['Yes ❑ No ❑ No Visible/Fine Layer ❑%2 to 1" 0>1" East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer 0% to 1" 0>1" West ❑ N/A f Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2to 1" 0>1" Facade Description: ti ' L.( — \ \

Roof t. Debris: ] No Visible /Fine tayer ❑ % to 1" •1 -4'"'A ❑ > 1" 1 Description:

Setbacks N/A s

Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y: to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Comments

Date: -/ ZX /2002 Inspection Team: Name: Agency: Name: Agency:

Agnil NYC-WTC 000117417