DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survev Form Premise Address: f-ya 4 f' (Q&.a9 /-3 Gry- c -s c. (at / /:3 t"<',Yy p~~ Block: Residential 0 Commercial j J Name of Building: Lot: Mix Use J Other ✓ # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: pp 4-t Name: nhe c Telephone Number: 2/ 2 ayy 2- /3 jr 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 0 Yes

Visual Inspection Results: Facade: Inspected Debris North 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'%z to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to V 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer to 1" ❑ > 1" Description: /3 áz ref / - fi- f/

Setbacks N/A Floor. _JLD Debris: 0 No Visible/Fine Layer 'Va to 1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer fl Va to 1" ❑>1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 4 to 1' 0>1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑>1" Floor: Debris: ❑ No Visible/Fine Layer ❑% to 1" 0>1"

Comments

Date: — 77 n Inspection Team: Name: //it7✓ Agency:.&P Name: Agency:

NYC-WTC—000118254