WTC Facade Inspection Form, 105 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: q0 Block: Residential EJ Commerciaf Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: 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 Q 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: I ected Debris North /A Yes QNa ❑ No Visible/Fine Layer D%to 1" 0>1" South ❑ N/A es ❑ No o Visible/Fine Layer ❑Yzto1" 0>1" East ❑ N/A j es ❑ No No Visible/Fine Layer ❑ v to 1" 0>1 0 West Q N/A DYes ❑ No ❑ No Visible/Fine Layer ❑Y=to 1" 0>1" Facade Description:

Roof

Debris: o Visible /Fine Layer ❑'/ to 1" "' `' ❑ > 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑V:to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: / /2002 Inspection Team: Name: Name: 9i<'L Agency: ________ Agency: fl

NYC-WTC 000118267