80 Beaver Street 127 Pearl Street BIN: 1000834

NYC 9/11 Public Portal Document

WTC Visual Survey Form I ODD?' U Pl' iiise Address: o Be4V`9P, aJt 1 P&#-et sf Block: a Residential D Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management. cy kyp►Ke. Telephone Number: P11 _._._._._._._._._._._._._._._._._._._._._._._._._._._._.. Name: /1 FAX: Address: 9, SC —A s On Site Contact: Name: ,n~a~-~- Telephone Number: ( ) Building Owner M nagement Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes D No Locations: Air Monitoring ❑ Yes No Locations- Copies of All Reports and Data Requested j Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Yes ❑ No ® No Visible/Fine Layer ❑'/2 to 1" South ❑ N/A Yes ❑ No [ No Visible/Fine Layer ❑ % to 1" East N/A J Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" Facade Description:

Roof

Debris: ine Layer INY2 to 1" O>1" Description:

Setbacks N/A Floor. 0 Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer O % to 1" ❑ > 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 1" ❑ > 1"

Comments

Date: /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000119003