DEP Request for Environmental Hazard Assessments, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: \5 4 vk Block: f Residential Commercial Name of Building: Lot: I Mix Use l Other # of Stories: AKA's: c. Building Own r a agement: Tel phone Number: (2 -t ) c1S ? - l SQj Name: FAX: ( ) Address: On Site Contact: Name: (-. — t~.r ~-- Telephone Number: ("' ) )3i Building Owner Mana ment ActivitieI Interior Survey Performed ❑ Yes ` No Exterior Survey Performed ❑ Ye 110 - General Clean Up- es to ations: '~ ACM Clean Up ❑ Yes- No Locations: Air Monitoring \❑ Yes~No Locations: "y Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North //A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1" South IPA?~;Y gf Yes ❑ No No Visible/Fine Layer ❑'/z to 1' ❑ > 1" East N/Ai EYes ❑ No No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A s ❑ No o Visible/Fine Layer ❑ % to 1," ❑ > 1" Facade Description: ti . %. (,k Q' v b ~ ~~

Roof / Debris: 'b'NQ Visible /Fine layer ❑ %z to 1" •7 ~"' ❑ > 1" 1 Description: % _4 - /I / l'()✓ , - / — (A

N/A/a Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"

Comments / /.~

/! r'

Date: S /f/2002 Inspection Team: Name: v-cc Agency: Name: Agency:

ab ENTERED

NYC-WTC-000118255