WTC facade inspection form, 41 Broad Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: Si Residential LJ Commercial El Block: Name of Building: Lot: Mix Use ❑ Other # of Stories: AKA's: • -

Sr. 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 0 Yes ❑ No ❑ No Visible/Fine Layer '/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer '/2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 1,4 to 1" ❑ > 1" El

Roof

Debris: Description: ❑ No Visible /Fine Layer I /2to 1" 0>1"

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer El 1/2 to 1" E1> 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1"

Comments

Date:.- / /2002 Inspection by: Name: I f tti (4ALj jAgency: Name: Agency:

NYC-WTC- 000118568