WTC building form, 75 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential Q Com a g►al 0 I Nameg Buildin• g Lot: # of Stories: Mix Use AKA's: Other. i~ t - ''~'~- t ~'\-c / _ t c ..4 Building Owner/Mana ment: Telephone Number: II Name: 1 e ,'8 FAX: Address: .............--.........................................- On Site Contact: .-~ c^ Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No 1 r Exterior Survey Performed ❑ Yes ❑ No v General Clean Up ❑ Yes ❑ No Locations: Cr 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 QYesDNo No Visible/Fine Layer ❑%to1" ❑>1" South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑%s to 1" O>1" East ❑ N/A ® Yes ❑ No No Visible/Fine Layer ❑%to1" ❑>1" West ❑ N/A E Yes ❑ No No Visible/Fine Layer ❑Yto1" ❑>1" Facade Descriotion:

Roof v~ Debris: No Visible /Fine aver n % to 1" n > 1"

Setbacks N/A) ' Floor: Debris: No Visible/Fine Layer ❑%to1° ❑>1" Floor: Debris: ENo Visible/Fine Layer ❑%to 1" ❑> 1" Floor: Debris:. ' No Visible/Fine Layer ❑%to1° ❑>1" Floor: Debris: No Visible/Fine Layer ❑ % to 1" O>1" Floor: Debris:..,❑ No Visible/Fine Layer ❑Yto1" ❑>1"

Comments - L1

Date: \_i /2002 Inspection Team: Name: I P "A } Agency: `°r ' Name: Agency:

NYC-WTC 000122484