DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: c~-t'c.~C~ ((at.~ l 1. /3 C J'~ ~` / t` 4'y ,'~" Block: Residential D Commercial jj Name of Building: Lot: Mix Use D Other fl # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: pp. h Name: poiz Q Telephone Number: 2/a) 5 .. /3 qt" 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 fl Yes

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

Roof

Debris: 0 No Visible /Fine Layer to 1" 0> 1" Description: /3 • ovr' sif / F /►n E .:. rz 1 ' r fu

Setbacks N/A Floor _JLO Debris: ❑ No Visible/Fine Layer 0'/a to 1" 0>1' Floor: Debris: ❑ No Visible/Fine Layer % to 1" ❑>1" Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑>1" Floor. Debris: ❑ No Visible/Fine Layer 034 to 1" L7 > 1" Comments

Date: ' Li Inspection Team: Name: Agency:P Name: Agency:

NYC-WTC-000118254