WTC debris inspection form for residential building, 2002

NYC 9/11 Public Portal Document

Ioi gog2 WTC Visual Survey Form Premiq d 9 B'141L S r. •

Block: Residential D Commercial 0 Name of Building: Lot: J14 Mix Use D Other # of Stories: AKA's: Building Owner/Management Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected bris North ❑ N/A ❑ Yes ❑ No 113 No Visible/Fine Layer ❑'/ to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No IJJ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No iljNoVisiblelFineLayer ❑'/ to l" 0>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑'/z

to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer 1 6 to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer /2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 'h to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: A/ /2002 Inspection by: Name: f. L . Agency: Name: Agency:

NYC-WTC-000119575