Asbestos inspection form, 125 Barclay Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: } 5 h C Block: Residential Q Commercial Name of Building: Lot: Mix Use Other # of Stories: AKA's: Building Owner/ nagement: Telephone Number: ( ) Name: C FAX:( Address:

On Site Con : Name: Telephone Number: ( ) Building Owner Manage ent Activities Interior Survey Performed es ❑ No Exterior Survey Performed . Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up es ❑ No Locations: Air Monitoring ies ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Yes ❑ No c'JNo Visible/Fine Layer ❑ % to 1" South ❑ N/A EYes ❑ No No Visible/Fine Layer ❑ % to 1" East ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ Y2 to 1" West ❑ N/A , Yes ❑ No No Visible/Fine Layer ❑'% to 1" Facade Description:

Roof

Debris: o Visible !Fine Lay ❑ Y to 1" ❑ > 1" Description: / f

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Vz to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer 0 % to 1" ❑ > 1"

Comments

4

Date: / 25 /2002 Inspection Team: Name: 7q Agency: Name: Agency:

NYC-WTC-000119416