WTC building form, 65 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise 4 r.essç7 A

Block: (~ Residential Commercial Name of Building: Lot: Mix Use j J Other # of Stories: AKA's: 1P—tNc ` Building Owner/Management Telephone Number. (7,tz.) e.r; e Name: FAX: Address: On Site Contac : L Name: 4 Building Owner Managemen Activities Telephone Number. (z t 2) tU Interior Survey Performed -Yes ❑ No Exterior Survey Performed 4es ❑ No General Clean Up ❑ Yes No Locations: ACM Clean Up ❑ Yes J J4o Locations: Air Monitoring Jzes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A es ❑ No No Visible/Fine Layer ❑ Va to 1" ❑ > 1" South ❑ NIA Yes ❑ No No Visible/Fine Layer ❑ Va to 1" ❑ > 1" East r] N/A Yes ❑ No 17No Visible/Fine Layer ❑ Va to 1" ❑ > 1" West j] N/A -Yes ❑ No o Visible/Fine Layer ❑ Va to 1" 0> 1" Facade Description:

Roof

Debris: NoVisibleIFineLayer ❑ % to 1"'1 =~'" 0>1" 3 -lorrrin4inn'' / ``

Setbacks N/A, ( Floor. Debris: ❑ No Visible/Fine Layer ❑ Ys to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'h 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 ❑ % to 1" ❑ > 1"

Comments ~r

Date: Inspection Team: Name: L L " < < '-" r~A9ency: Name: Agency: ENTERED

NYC-WTC 000122469