WTC building form, 75 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential D Com a dial D I Name ol Build na: Lot: Mix UseD Other. ""' ~-1 ~'~ C (4 # of Stories: AKA's: Building Own r/Mana ent: Telephone Number:; P II Name: ~' e !;J\et FAX:( ) ------------------------------ Address: On Site Contact: , Name: c \ 1 Telephone Number. ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No • Exterior Survey Performed ❑ Yes ❑ No 'r 1~k v~ 1 General Clean Up ❑ Yes ❑ No Locations: `` G- ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A es ❑ No -V_No Visible/Fine Layer ❑'/ to 1" ❑ > I" ❑ > 1" South East West ❑ N/A ❑ N/A ❑ N/A DYes ❑ No ❑ Yes ❑ No QYes ❑ No -d No Visible/Fine Layer ❑ V2 to 1" No Visible/Fine Layer ❑ Y2 to 1" No Visible/Fine Layer ❑V to 1" ❑ > 1" ❑ > 1" Facade Description: s ,

Roof i yt

Debris: No Visible /Fine r ❑'/ to 1" 1 ❑ > 1" 1 Descriptio ~ S i ,

Setbacks N/A Floor: Debris: VNo Visible/Fine Layer ❑ % to 1" Floor: Debris: No Visible/Fine Layer ❑ V2 to I" Floor: Debris:. No Visible/Fine Layer ❑ % to 1" Floor: Debris: [ No Visible/Fine Layer ❑ V to 1" Floor: Debris:, No Visible/Fine Layer ❑ V2 to 1"

Comments

Date: I/ /2002 Inspection Team: Name: Agency: yL \ Name: Agency:

15 NYC-WTC 000122483