DEP letter requesting hazard assessments, February 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: 2Q Reside tial CommercialD Name Building: Lot: Mix Use Other ❑ IQ # of Stori s: AKA's: Building Owner/Management: Telephone Number: ( ) Name: - FAX: ( ) Address: On Site Contact: Name: Telephone Number: ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes [] No ❑ No Visible/Fine Layer ❑Y2to 1" 0>1" South ❑ N/A ❑ Yes ❑ No O No Visible/Fine Layer ❑'/2 to 1" 0>1" East _ /A ❑ Yes ❑ No o Visible/Fine Layer ❑%to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" 0>1" Facade Description:

Roof VS Debris: ❑ No Visible (Fine . yer ❑'/z to 1" ❑ > 1" 'I Description:

Setbacks N/A Floor. 9 Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %s 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 ❑ % to 1" ❑ > 1"

Comments

Date: Inspection Team: L 7c t-' '' gency: C Name: Agency: 0 a6 NYC-WTC-000118059