80 Beaver Street 127 Pearl Street BIN: 1000834

NYC 9/11 Public Portal Document

WTC Visual Survey Form I OOD''?? '/ mise Address: ~s+o B 'W aJt I P& -r sqJ - . Block: a Residential U Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management y kyp►c Telephone Number: (Z.l Z) 22 —IC,-91 4 Name: / '' FAX: Address: 9, P,C—A s On Site Contact: Name: • , 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 fl 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 I" East E N/A D Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Va to 1" Facade Description:

Roof

Debris: ine Layer -pg Y2 to 1" ❑ > 1" Description:

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

Floor: Debris: ❑ No Visible/Fine Layer ❑Y2 to 1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer ❑%to1" 0>1" Floor: Debris: ❑ No Visible/Fine Layer ❑%tol" 1:1>1"

Comments

Date: 1. /2002 Inspection Team: Name: M Agency: Name: Agency:

NYC-WTC-000119003