WTC environmental inspection form, 104 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form emise Address: Ez Block: Residential Commercial jJ Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: j - LA'r" l 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 ❑%to1" 0>1" South 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" Facade Descri tion•

Roof

Debris: No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description:

Setbacks Floor. Debris: ❑ No Visible/Fine Layer ❑'% to 1 0 ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" ❑ > 1"

Comments

Date: - — Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000118262