DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: "

Block: Residential Commercial 0 I Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: AKA's: rpJc C ^ Building Own r a agement: Tel phone Number: (2 - ) Name: ti r -- 1 ' '---- FAX: ( ) Address: On Site Contact:(- Name: \ L _ v Telephone Number: (:!\2) ma r Building Owner Mana ment Activiti Interior Survey Performed ❑ o Exterior Survey Performed ❑ Ye o General Clean Up.]}d'es Ye:Eations: Jo ACM Clean Up 1❑ Yes. NNo Locations: Air Monitoring ❑ YesfNo Locations: .../ V Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North I/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" South N/A ~- gjYes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ,E'N/A1 EYes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1" West ❑ N/A s ❑ No o Visible/Fine Layer ❑'/ to " ❑ > 1" Facade Description: SJ1 V II t C ~^

Roof {,.art ❑> I t. Debris: 'bNQyisible ine iyer ❑ Y2 to 1" .1 I" Description: 1

f

Setbacks N/AI Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"

Comments C F IA I~

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Date: /_ 2 /2002 Inspection Team: Name: I C- \- - Agency: Name: Agency: _

E NYC-WTC-000118252