Asbestos inspection form, 111 Broadway, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ~llvw Block: Residential D Commercial Name of Building: Lot: Mix Use J Other # of Stories: iA AKA's: Building Management: Telephone Number: (2 z) 3 r — C Name: Own7ev C FAX: Address: On Site Contact Name: * ' C''v \ Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed JYes ❑ No Exterior Survey Perfon ed Ces ❑ No General Clean Up ZYes ❑ No Locations: ACM Clean Up es ❑ No Locations: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Requested es i\ Visual Inspection Results: Facade: inspected Debris North ❑N/A RJYesDNo ❑ No Visible/Fine Layer E]'/ to 1" 0>1" South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑'/2tol" 0>1" East ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑'/2to1" 0>1" West ❑ N/A Q-Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" 0>1" Facade Description:

Roof . Debris: 'No Visible /Fine yer ❑ Y2 to 1" 1~~"" ❑ > 1" 1 Description:

Setbacks NIA ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: [] No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer 0'/2 to 1" ❑ > 1"

Comments

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Date: k '\ i 12002 Inspection Team: Name: L ') Ct (1','Y't.. Agency: Name: Agency: E r NYC-WTC 000122503