Building Inspection Data Form, 57 Ann Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential Commercial ame of Bi D TN c'TZ Lot: Mix Use ❑ Other ❑ C 4Grtc z'D # of Stories: AKA's: Telephone Nut Building Owner/Managemen pC._FAX:( No t.Io- t! S , Name: P ) Address:

Name: 1 __ Telephone Nur ?2? wilding 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: Conies of All Reports and Data

Visual It Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/ 2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [1 1/ 2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑%to1" 0>1" Description:

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

Comments

Date: /_?„012002 Inspection by: Name: C.L . Agency: Agency: Name:

NYC-WTC-000119747