DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: y \5 Block: Residential Commercial Name of Building: Lot: Mix Use Other ❑ # of Stories: AKA's: c.-- Building Own r a agement: `` Tel phone Number: (2z- ) Cl S ? _ 5a ti.-- - ) IS Name: FAX: ( Address: On Site Contact:-' Name: Telephone Number: ( — ~zj 1 ) Building Owner Mana ment Activitie Interior Survey Performed ❑ Yes No , Exterior Survey Performed ❑ Ye o General Clean Up 2eslo ations: ACM Clean Up 1❑ Yes- No Locations: ) Air Monitoring 1❑ Yesjlo Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North IA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" South N/A ~- VYes ❑ No No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East N/A1 Yes ❑ No No Visible/Fine Layer ❑'/z to 1" ❑ > 1" West ❑ N/A Yes ❑ No o Visible/Fine Layer ❑ Y2 to " ❑ > 1" Facade Description: ff

Roof U ~ 4 4 Debris: [ P~V̀isible /Fine Tayer ❑ %2 to 1" ❑ > 1" Description: 1

Setbacks N/A 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 ❑ 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments Kl c ;mac

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Date: I /2002 Inspection Team: Name: '- Agency: Name: Agency:

ab E N T E A

NYC-WTC-000118255