WTC building form, 65 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Add ess~ bS Block: Residential Commercia Name of Building: Lot: Mix Use Other # of Stories: AKA's: iyy F-t N c , Building Owner/Management: Telephone Number: (2 ) 3 Name: FAX: Address: On Site Contact• ~ - '- Name: ' viio~ \b&(\'— Telephone Number: 2 t 2 o U Building Owner Managemen Activities Interior Survey Performed - Yes ❑ No Exterior Survey Performed es ❑ No General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes J FNo Locations: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Requested Yes J Visual Inspection Results: Facade: inspected Debris North ❑ N/A es ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑'/ to 1" ❑ > 1" East ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A Yes ❑ No • No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: No Visible /Finel.ayer ❑ Y2 to 1" ? ' ❑ > 1" !

Setbacks N/A Floor. Debris. ❑ No Visible/Fine Layer ❑ / to 1" ❑>1 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 ❑ % to 1" 0> 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments L & -k.- L, c,•~' w?c _ c: ro t-11i

a,•~..:~...-

{ . e Date: Inspection Team: Name: L ~-- - k r C~~Agency: Name: Agency:

NYC-WTC 000122468