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NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: G ~' ,w(l •

Block: Residential Commercial J Name of Building: Lot: Mix Use J Other #of Stories: AKA's: Building Owner!Mana ement: 9 Telephone Number: ( ) Name: FAX: Address: On Site Con ct: Name: \ '- `"^-~ er~seo Telephone Number: ( .2 e 2) ' 1 - 2c t: G Building Owner Management Activities Interior Survey Performed ["Yes ❑ No Exterior Survey Performed Q Yes ❑ No General Clean Up ❑'Yes ❑ No Locations: ACM Clean Up 0 Yes No Locations: Air Monitoring Q'Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

visual inspection Results: Facade: Inspected Debris North ❑ N/A ['Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" ❑>1" South ❑ N/A ['Yes ❑ No ❑ No Visible/Fine Layer ❑%2 to 1" O>1" East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" O>1" West ❑ N/A f Yes ❑ No ❑ No Visible/Fine Layer ❑Y2 to 1" O>1" Facade Description: (L.J _~ c,iJ»~.~~, S.S ~' ,~jL_.~ —,.1 ' • ~'jr.n._ ~~_~,?,;~—. ~r.?_C

Roof k. Debris: ] No Visible /Fine ayer ❑ %2 to 1" •1 '' ❑ > 1" 1 •~ "'~ Description:

Setbacks N/A [ 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 ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Comments

Date: -/ 'f /2O02 Inspection Team: Name: Agency: Name: Agency:

Agnil NYC-WTC 000117417