WTC debris inspection form: 174 Broadway, Oct 2000

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercial p Name of Building: Lot: 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 [J Yes L] No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes 0 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" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" West ❑ N/A [] Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" 0> 1" Facade Description:

Roof

Debris: [] No Visible /Fine Layer tot" ❑>1" Description:

Setbacks N/A 0 Floor. Debris: ❑ No Visible/Fine Layer 0 to 1" Floor. Debris: ❑ No Visible/Fine Layer 0 1/ 2 to 1" Floor: Debris: ❑ No Visible/Fine Layer 0 1/3 to 1" Floor. Debris: 0 No Visible/Fine Layer 0 % to 1" Floor. Debris: ❑ No Visible/Fine Layer 0 1/2 to 1"

Comments ~citeAid

Date: / / ' /2t Inspection Team: Name: ` Agency: Name: Agency: ENTE R

NYC-WTC 000122618