Facade inspection form, 155 Cedar Street

NYC 9/11 Public Portal Document i '_ - _

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WTC Visual Survey Form remise Address:

Block: Residential 0 CommercialD Name of Building: Lot: Mix Use ❑ 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 J Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ V to 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /z to 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /s to 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑ 2 to 1" 0> 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ /Z to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ 2 to 1" ❑ > 1"

Comments

Date: by: Name: •L_ Agency: Name: Agency:

NYC-WTC 000122334