WTC facade inspection form, 74 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form •Premise Address:

Blodk: Residential 0 Commercial Name of Building: Lot. Mix UseD OtherlJ # of Stories: AKA's: Building Owner/Management rt

Telephone Number. ( ----

) Name Cc- C ~- FAX: Address: On Site Contact Name: ' - - Telephone Number. Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed g Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring j] Yes [] No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑YesQNo ❑ No Visible/Fine Layer .4to1 9>1' South ❑ N/A 9Yes9No ❑ No Visible/Fine Layer ❑%to1" 0>1" East ❑ N/A DYes0No ❑ No Visible/Fine Layer 034t01' 0 > 1" West QN/A []YesQNo ❑ No Visible/Fine Layer j/: to 1" 0>1' Facade Description: ,

Roof

Debris: No Visible /Fine Layer n%to1" 0>1" Description:

Setbacks N/A Floor - Debris:D No Visible/Fine Layer D % to 1" > 1" Floor____ Debris: 0 No Visible/Fine Layer Q % to 1" 0> 1" Floor. Debris: 0 No Visible/Fine Layer 9 % to 1" 0>1' Floor Debris: 0 No Visible/Fine Layer 9% to 1" 0>1' Floor Debris: ❑ No Visible/Fine Layer 9i4 to 1" 9> 1" Comments

Date: f/_ T0 Inspection Team: Name: Name: Agency: - Agency:

NYC-WTC 000118310