DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: W.Mh- Block: ResidentiJ Commercial Name of Building: Lot: Mix Use D Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site CQn•tà -------------------------------------------------------- Name: l 't - ' Telephone Number: P11 ._._._._._._._._._._._._._._._._._._._._._._ Building Owner ManagementActi ies Interior Survey Performed ❑ YesFJ 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: Injpected Debris North ❑ N/A Yes ❑ No Visible/Fine Layer ❑%to l" O>1" South ❑ N/A es ❑ No Jo Visible/Fine Layer ❑'/atol" ❑>I- East ❑ N/A Eyes ❑ No ❑'N Visible/Fine Layer [:]'/z to l" O>1" West ❑N/A Eyes❑No J2f o Visible/Fine Layer ❑%to l" O>1" Facade Description:

Roof

Debris: 'No Visible /Fine Layer ❑'/s to 1" `' ' ❑ > 1"

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

Comments

Date: ! /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000118253