WTC facade inspection form, 176 Broadway, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address `

Block: Residentiai. Commer 'al Name of Building: Lot: Mix Use J Other # of Stories: AKA's: Building Owper/Mana~em t: Telephone Number. (-at s) 310 • e ~$ o Name: oLe•. '3, 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 Inscection Results:

Inspected Debris North ❑ N/A ❑ Yes [] No ❑ No Vsible/Fine Layer ❑ Y2 to 1" [3>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer E)Y to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: [] No Visible /Fine Layer z to 1" 0> 1" Description:

Setbacks N/A[] Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" [3 >1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" tJ > 1"

Comments • 41.L4 cØ.j ¶/t-e .t4W/ I 1 . /4oieit

Date: Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000122688