WTC Facade Inspection Form, 105 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1000 „ Premise Address: IC Block: 17 ResidentialD CommercialD Wame of Building: Lot: 31 Mix Use 0 Otherfl # 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 ❑ 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" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" D>1 East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yato1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1" Facade Description: ice_

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Roof

Debris: to Visible /Fine Layer ❑ % to 1" ❑ > 1" Description:

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

Date: / 002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000118269