WTC Visual Inspection Form, 15 Broad Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: /5 $,2o cr Block: Residential 0 Commercial Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number. ( ) Name: FAX: Address: On Site Contact: r Name: Telephone Number. Z/ Z) -3s= lB Building Owner Management Activities Interior Survey Performed ❑ Yes 0 No Exterior Survey Performed ❑ Yes 0 No General Clean Up 0 Yes 0 No Locations: ACM Clean Up 0 Yes 0 No Locations: Air Monitoring ❑ Yes 0 No Locations: Copies of All Reports and Data Requested DYes

visual insoection Kesults:

Inspected Debris North 0 N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑% to 1' ❑ > 1" South ❑ N/A ❑ Yes 0 No ❑ No Visible/Fine Layer 0 % to 1" 0>? East 0 N/A ❑ Yes 0 No ❑ No Visible/Fine Layer ❑ % to V ❑> V West 0 N/A 0 Yes 0 No ❑ No VsiblelFine Layer ❑ % to l* ❑ > 1" Facade Description:

Roof

Debris: .0 No Visible /Fine Layer K'h to 1" 0 > 1" Description: .7)F_ 3,e/

Setbacks N/A ❑ Floor. Debris: 0 No Visible/Fine Layer ❑ % to? 0>? Floor. Debris: 0 No Visible/Fine Layer 0'/: to V > 1" Floor: Debris: 0 No Visible/Fine Layer D'h to V R>10 Floor: Debris: 0 No Visible/Fine Layer D% to V ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer D% to V [J> V

e

Date: 3 I?3 I7J2 inspection Team: Name: P4f 7?.4v<#9V Agency: Name: Agency:

NYC-WTC-000118701