DEP Request for Environmental Hazard Assessments, Feb 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: 4 I Residential J CommercJ Name of Building: Lot: Mix Use ❑ Other # of Stories: AKA's: r ~` Building..Qwner/Management: ❑c = Telephone Number: (2- Name: i (' - FAX: ( ) Address: On Site Contact: Name: ~ i 'Y ~ Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed 'Yes ❑ No Exterior Survey Performed [ Yes ❑ No 1j i ~ -_ General Clean Up ❑ Yes'af o Locations: ACM Clean Up ❑ Yes. 'No Locations: Air Monitoring _ .Yes ❑ No Locations: Copies of All Reports and Data Requested es

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A 5'es ❑ No '-No Visible/Fine Layer ❑'/2 to 1" [3 >1" South ❑ N/A nYes ❑ No [ No Visible/Fine Layer ❑ '/Y to 1" [3 >1" East ❑ N/A Yes ❑ No 3No Visible/Fine Layer ❑ 1/z to 1" [3 >1" West ❑ N/A RYes ❑ No ❑ No Visible/Fine Layer ❑ 1/z to 1" [3 >1" Facade Description:

Roof 4 5t

Debris: ''moo Visible /Fine ayer ❑'/z to 1" 1 ~"' [3 >1" 1 ~'~

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

Comments / f

Date: ❑/x/2002 Inspection Team: Name: L^ tgency: fl Name: Agency:

t NYC-WTC- 000118246