Asbestos inspection form, 111 Broadway, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Access: w Bloc Residential D Commercial Name of Building: Lot: Mix UseJ 9t r # of Sto es: AKA's• r — a Building Own r/Management:~ Teleph_ ne Number:;._ _ PI Name: v l ri 1 V FAX: P11 .._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.. Address: On Site Contact Name: ' Telephone Number: ( ) ^---~— Building Owner Management Activities Interior Survey Performed JYes ❑ No Exterior Survey Performed s ❑ No General Clean UpZJYes ❑ No Locations: ACM Clean Up es ❑ No Locations: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Requested es

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ,'~ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East ❑ N/A Q Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A a -Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof j. Debris: Visible /Fine ayer 0 114t01"'1 = O>1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1"

Comments , C~ -, f~vue(1

( /• d ` a ) 1! (' /)'I 1 11/11,, fi ll • l~ 3

Date: / /2002 Inspection Team: Name: Agency: Name: Agency: J NYC-WTC 000122505