WTC debris inspection form: 170 Broadway, Oct 2000

NYC 9/11 Public Portal Document

WTC Visual Survey Form E1 too 1 s

Premise Address: (7 ® 'Broad wa Block: (0 Residential 0 CommerciaJ Name of Building: Lot: f Ip Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number. ( ) Name: FAX: Address: On Site Contact: Name: Telephone Number. Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Vsible/Fine Layer % to 1" 0>1" South ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer % to l" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" 0>1" Facade Description:

Roof

Debris: Visible /Fine Layer ❑ % to 1" 0>1" Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑ . to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0> 1" Comments

Date: r,J / I5 12002 Inspection by: Name: FP Agency: DEP 1 Name: Agency:

NYC-WTC 000122555