WTC building form, 315 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

WTC Visual Survey Form /00 f (os T;z Premise Address: Block: ) Residential 1 CoInmercial Name of Building: Lot: cg Mix Use Otherfl # of Stories: 4, AKA's: >1 3 - 31 Building Owner/Management Telep a Number j Name: 15 o A o -r FAX: Address: c PMLK. — On Site Contact Name: Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes 8 No General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes 9 No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes Visual inscection Results: Facade: Inspected Debris EJ /A 9 Yes ❑ No North South East [ ❑ A NN/A Yes No es No 0 No Visible/Fine Layer Visible/Fine Layer 9 16 to 1 '

3~4 to 1' No Visible/Fine Layer ❑ % to 1' L] > 1' ❑ > 1' 0>1. West [/A DYes 9 No ❑ No Visible/Fine Layer 016 to 1' ❑ > 1' Facade Description:

Roof Debris: [j'No Visible /Fine Layer D 4 to 1' 9>1k Description: p A

Setbacks N/A Floor Debris: No Visible/Fine Layer ❑ 34 to 1' Floor____ Debris: No Visible/Fine Layer 34 to 1' Floor Debris: No Visible/Fine Layer 34 to 1' Floor____ Debris: No Visible/Fine Layer 36 to 1' Floor.____ Debris: No Visible/Fine Layer 36 to 1' Comments

Date: ~'? J t Jr4 O2 Inspection Team: Name: ►~`'~ Agency: uy~'" Name: _ Agency:

NYC-WTC 000122458