WTC building inspection form, 115 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: -? e

Block: Residential EJ Commercial G-' Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management: `"" Telephone Number. ( ) Name: J i> fr2 + - SC FAX: Address: On Site Contact: Name: - ' .. Telephone Number: 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 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 ❑ Ya to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1' West ❑ N/A ❑ Yes ❑ No ❑ No Vsible/Fine Layer ❑ Y to 1" []> 1' Facade Description:

Roof

Debris: o Visible /Fine Layer 91/2 to 1" ❑ > 1" Description:

Setbacks N/A f Floor. Debris: 0 No Visible/Fine Layer 0 i4 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Yz to 1" ❑ > 1" Floor. Debris: ❑ No VSible/Fine Layer ❑ %% to 1" 0> 1" Floor. Debris: ❑ No VSible/Fine Layer ❑ % to 1" 9> 1" Comments

Date: Inspection Team: Name: Agency: E o

Name: Agency:

NYC-WTC-000118257