WTC building form, 80 Broadway, DEP Box 49

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 0 ROAtwA Block: Residential ❑ Commercial Name of Buildilnng: Lot: Mix Use ❑ Other ❑ ECur o . # of Stories: AKA's: Building Owner/Mane ement: Telephone Number: (a 1 ) — (o Name: \, p4 FAX: ( ) Address: -'sb oo ckLl N2w 'Jo r (O 2 AC1 On Site Contact: Name: Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No ~D fib. ry a (~- General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requeste Yes P( P u Ser \l~ o visual inspection Kesuits: Facade: Inspected Debris North ❑ N/A ® Yes ❑ No No Visible/Fine Layer El ½ 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 /Fine ❑>1„ ❑lto1" K Description: R\O OC.C2.

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1"

Date: I'? /2002 Inspection by: Name: Name: gency: 4c p? g _ Agency:

NYC-WTC-000122487