Asbestos inspection form, 111 Broadway, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise A ess: *Yk—oW Block: ResidentialD Commercial Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Management: Telephone Number: (2 z) 31V — I -L c Name: OwnVEV i J o C FAX: Address: On Site Contact: Name: Telephone Number ( ) ^-->-- Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed, es ❑ No General Clean UpZJ\'es ❑ No Locations: ACM Clean Up es ❑ No Locations: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Roquested es

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A J Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" 0>1" South ❑ N/A ®.Yes ❑ No ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1" East ❑ N/A 0 Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" West ❑ N/A Q -Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof u t. Debris: Visible /Fine. ayer ❑ %2 to 1" 0>1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" Comments i ie fr ff e

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Date: k//2002 Inspection Team: Name: (MI- L C, l'1 'i 'Y Agency: Name: Agency: l=r' lED 1.2 NYC-WTC 000122504