Building inspection form for 55 [name], undated

NYC 9/11 Public Portal Document

1001271 WTC Visual Survey Form Premise A d :

Block: Residential fl Commercial J J Name of Building: Lot: Mix Use J Other # of Sto es: 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 0 Yes ❑ No Locations: Air Monitoring 0 Yes ❑ No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑to1" ❑>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑4to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" Facade Description:

Roof

Debris: Description: 0 No Visible /Fine Layer M% to 1" 0>1"

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer 034 to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Comments

Date: Inspection by: Agency: Name: Agency:

NYC-WTC-000119692