WTC building inspection form, Block 34

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WTC Visual Survey Form Premise Address: Ar Block: J2L Residential Commercial Name of Building: Lot: 34 Mix Use ❑ Other ❑ # of Stories: AKA's: Building owner/Management a,za- Telephone Number: ( ) f, 2 Name: FAX: ( ) Address: On Site Contact: Name L L C ri - -'C f i Telephone Number: ( tl ) Building Owner Management Activiti s 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 R Yes ❑ No ] No Visible/Fine Layer ❑'/ to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1 n [3 >1" East ❑ N/A ❑c Yes ❑ No No Visible/Fine Layer ❑ 1/tot" ❑>1" West ❑ N/A J Yes ❑ No No Visible/Fine Layer ❑'/2to 1" [3 >1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑'/Z to 1" ❑ > 1" Description:

Setbacks N/A ❑ 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 ❑'/2 to 1" [3 >1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" [3 >1" Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" [3 >1"

I _ Date: /_/2002 Inspection by: Name Cori L~s'~ ' -4,; Yesency: ~~. ~. 3 Name: Agency:

NYC-WTC-000118240