WTC debris inspection form: 174 Broadway, Oct 2000

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 ioQ'

Q Premise Address: I r7 q 'Broad w a j Block: Residential 0 Comme al Name of Building: Lot: . MixUseD Other # of S oriel: AKA's: Building OwnerlManagement: 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 P011 15 North ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑'/to1" 0>1" South ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer 034t01" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑to1" ❑>1" West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ % to l" 0>1" Description: IF

Setbacks N/A[] Floor Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0 1/2 10 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments

Date: 9c / I5 /2002 Inspection by: Name: A? Agency: EP Name: Agency:

NYC-WTC 000122616