WTC building inspection form, mixed-use commercial structure, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1 0()(),S-3'Y Premise Address: ,8 MV afire. 1j P&.'yf S1Yue . Block: 07 Residential 0 Commercial Name of Building: Lot: Mix UseD Other #of Stories: AKA's: Building Owner/ManagementQ ç.,- -p 6e. Telephone Number: (2r z.) tf z2—►t~S~ Name: / FAX: Address: fsb 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A I YesDNo ® No Visible/Fine Layer - ]'/2 to 1" 0>1" South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑'/2 to 1" 0>1" East N/A DYesDNo ❑ No Visible/Fine Layer ❑/2 to T' 0>1" West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /2 to 1" 0>1" Facade Description:

Roof

Debris: Pine Layer /2 to 1" 0>1" Description:

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

Comments

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

NYC-WTC-000119006