WTC debris inspection form: 170 Broadway, Oct 2000

NYC 9/11 Public Portal Document

WTC Visual Survey Form P 1 Premise Address: 11 Block: I Residential 0 Commercial Name of Building: Lot: 1 (v I Mix Use J J OtherIJ # of Stories I AKA's: Building Owner/Manageme Telephone Number: ( ) Name: YYl (- L FAX: k3 S 3 Address: On Site Con t: Name: c4~ v~,.~.c... • Telephone Number: Building Owner Management ctiviti Interior Survey Performed es ❑ No Exterior Survey Performed ❑4(es ❑ 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 p Yes

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 ❑ Yz to 1" 0>1" East -ETNTA Yes ❑ No Flo Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West 7A J Yes ❑ No J.No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Facade Desc iption:

Roof _ Debris: 9 'o Visible /Fine Layer ❑%to1" ❑>1" Description:

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

Date: /1/2002 Inspection Team: Name: Name: C1X. L Agency: h Agency: NTERE6 NYC-WTC 000122559