DEP request for environmental assessments, 277 Broadway, Feb 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form (o O16 -3 t7 Premise Address: -7 7 l~

Block: Residential Commercial Name of Building: Lot: 3 Mix Use ❑ Other 6,,1, P, t L;;n,, r,n n. # of Stories: / S AKA's: Building Owner/Manageme : Teleph Num er. (i,i ) - s,6 s a Name: FAX:( ) Address: On Site Contact: Name: /. / I. - - Telephone Number. , Z) 3 Building Owner Management Activities Interior Survey Performed ❑ Yes J 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 Yes

visual inspection Kesults: Facade: Inspected Debris North Q N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to l" 0>1" South ❑ N/A fZ Yes ❑ No ] No Visible/Fine Layer ❑%to 1" 0>1" East ❑N/A ®Yes❑No QC No Visible/Fine Layer ❑%to 1" 0>1" West (i N/A [] Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" ❑> 1" Facade Description:

Roof " Debris: No V ~s le Fine ayer b ❑'/ to 1" •, ' ❑ > 1" " Description:

Setbacks N/A s] Floor: Debris: ❑ No Visible/Fine Layer 3 D 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 ❑ %s to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments •

Date: /__/ 2'/ /2O2 Inspection Team: Name: /3 • h Z /'•1 '+•I (( Agency: c/S E/74 Name: /Z , , a c . .i, Agency: /L`'-i e DE

NYC-WTC 000122422