Cover sheet for asbestos analysis transmission, June 2002

NYC 9111 Public Portal Document

WTC Visual Survey Form &6r &øw7y Premise Address:

Block: I Residential D Commercial Name of Building: Lot: Mix UseD Other # of Stories: I AKA's: Building Owner/Management: Telephone Number: (t oz ) Z s - -)c'4, Name: L S1EA FAX: Address: r- 3.t'i fo ,l N• . /0.07 On Site Contact: Name: i 2- /I , Telephone Number: z.s ) AT 3., I Building Owner Management Act,lties Interior Survey Performed ❑ Yes ❑ No '? Exterior Survey Performed ❑ Yes ❑ No General Clean Up ® Yes ❑ No Locations: m• f • r#r.0 F/+ I k. ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested f J Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine La er ❑ % to 1" ❑ > 1" South ❑ N/A Yes ❑ No No isibl ine ❑ % to 1" 0>1" East ❑ N/A J Yes ❑ No o Visib in a er ❑ % to 1" 0>1" West ❑ N/A ® Yes ❑ No ® o isi I me Laye ❑ /2 to 1" ❑ > 1" Facade Description: V1.4•. c,;~:~ C -" --.4t

Roof s~ Debris: ® No Visible ine aver ❑ Y to 1" •1 ❑ > 1" 1 Description: SM.ore /i, .►... c aF' 6'Tc f4 to de6.. a

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

Comments

Date: I / /2002 Inspection Team: Name: Agency: V £47 Name: Agency:

NYC-WTC 000122403