WTC environmental inspection form, 395 South End Avenue, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential. Commercial p Name of Building: Lot: pQ Mix Use Other J J 1 # of Stories: AKA's: ft te Building Owner/Management: 1) Telephone Number: ( ) Name: FAX: Address: On Site Contact: ~~ Name: L~ ' '< s U Telephone Number: 2 + a-) 32 t -22 U ~: Building Owner Management Activities Interior Survey Performed I3S'es ❑ No Exterior Survey Performed I 'Yes ❑ No General Clean Up [Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes [. No Locations: Copies of All Reports and Data Requested [J Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A 0 Yes ❑ No ❑ No Visible/Fine Layer ❑/atol" ❑>1" South ❑ N/A [aYes ❑ No ❑ No Visible/Fine Layer ❑'/tol" ❑>1" East ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1" West ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" ❑>1" Facada Descnption. , L -u

Roof

Debris: ❑ No Visible /Fine Vti yer ❑ % to 1" 1 ; > 1" "1 Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments -

. 1 Date: / /2002 Inspection Team: Name: _ Agency: Name: Agency:

NYC-WTC-000117609