WTC debris inspection form: 170 Broadway, Oct 2000

NYC 9/11 Public Portal Document

WTC Visual Survey Form P ? Premise Address:

Block: (o L{ Residential Commercial Name of Building: Lot: (o Mix Use Other # of Stories: AKA's: Building Owner/Manageme : Telephone Number: ( Name: Y C FAX: 3 S 3 Address: On Site Contact Name: Telephone Number: Building Owner Management Activiti Interior Survey Performed es ❑ No Exterior Survey Performed ['es ❑ No '~ 1A- General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested J Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A ❑ Yes Q No ❑ No Visible/Fine Layer 0114t01" D>1" East 9 1TA Yes ❑ No Flo Visible/Fine Layer ❑ % to 1" ❑ > 1" West N7A 'es ❑ No Q No Visible/Fine Layer ❑ V2 to 1" ❑ > 1" Facade Desc iption:

Roof _ Debris: .[ lo 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 ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments

Date: Inspection Team: Name: L Agency: iJ Name: Agency: ENTERED NYC-WTC 000122559