Asbestos inspection form, 111 Broadway, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Add ess: w Bloc x: Residential 0 Commercial Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Own r/Management: Telephone Number: (z i z. ) 3 3 1 - - . c Name: n% 1 R CC FAX: Address: On Site Contact: Name: \&\)" t"-' Telephone Number: Building Owner Management Activities Interior Survey Performed Q Yes ❑ No Exterior Survey Performed es ❑ No General Clean UpZ1Yes ❑ No Locations: ACM Clean Up es ❑ No Locations: Air Monitoring es ❑ No Locations: Copies of All Reports and Data Roguested es Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Rj Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" East ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" West ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description: K i

Roof sx, str W Debris: No Visible /Fine ayer ❑ % to 1" •1 - ' 0>1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" 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 0 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Comments > r

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Date: \/ /2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000122507