Asbestos inspection form, 57 Ann Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: a

Block: g Residential Commercial 0 Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: AKA's: Building Owner/Managemen • Telephone Number: ( ) Name: jo C . FAX: ( ) Address: — On Site Contact:- Name: -• Telephone Number: ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed - ❑ Yes ❑ No ,Y General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Request Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" El > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

• Roof •

Debris: ❑ No Visible /Fine Layer ❑ % to 1" 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

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r,. Date: Inspection by: Name: ( , . Agency: H I- Name: Agency:

NYC-WTC-000119764