Visual survey form for building facade inspection

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Promise Address: Z _ p''` ~.✓ /~ Cam. ' y

Block: Residential El ommercial E j Name of Building: Lot 7 Mix Use ❑ Other ❑ I t 4 -- # of Stori s: AKA's: Building Owner/Management: Telephone Number: ( t ) &% f Name: , c~. . FAX ( ) Address: On Site Contact: Name: ; Telephone Number: (2 i ) C. 5L, . y 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` -. es

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 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 El 1/2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer „❑ Y2 to 1" ❑ > 1" Description: ` t e k S i _ l _C A-t , t

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

Comments

Date: / ~~ r /2002 Inspection by: Name: Agency: Name: Agency:

NYC-WTC-000118672