WTC building inspection and visual assessment form

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address;;' C / 1 ' 'h h- 11 5 l< w c 'l Block: Residential LI Commercial LI Name of Building: Lot: Mix Use Other ❑ I t E ) t # of Stories: S AKA's: Building Owner!Man gement: Telephone Number: (L, x ) -3 - Name: /)E t FAX: ( ) Address: On Site Contact: Name: C'i'r'R ^A r- ; c a - /`i cf Telephone Number: t 2-/L ) Building Owner Management Activities Interior Survey Performed ❑ Yes ® No Exterior Survey Performed ❑ Yes ( No General Clean Up [] Yes ❑ No Locations: .: ~; . ACM Clean Up ❑ Yes a No Locations: Air Monitoring ❑ Yes[] No Locations: Copies of All Reports and Data Requested LI Yes

visual inspecuuri r%C*uiw. Facade: Inspected Debris North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" South ❑ N/A Q Yes ❑ No [j] No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1" West 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" [1]> 1" Facade Description: 77 LJ '

Roof

Debris: ❑ No Visible /Fine Layer '/2 to 1" •I "'~ ❑> /'wear ,.` ~ ,, Description: s / ;- -(` ;n.y~ t/

Setbacks N/A 0 Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2. to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments

Date: / ti , /2002 Inspection Team: Name: IL z Agency: L Name: ; i:, r,,,., Agency: L

39 NYC-WTC 000122268