WTC facade inspection form, 176 Broadway, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1001100 Premise Address: ,1(D Broadway Block: Residential 0 commerciafTj Name of Building: Lot: Mix Use J Other # of Sto es: 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 ❑ 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 RequestedI JYes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No Visible/Fine Layer ❑1 to 1" 0>1" South ❑ N/A ❑ Yes ❑ No Jo Visible/Fine Layer ❑ % to 1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" West ❑ NIA ❑ Yes ❑ No o Visible/Fine Layer ❑ Ya to 1" 0>1" Facade Description:

Roof

Debris: M No Visible /Fine Layer ❑ Va to 1" ❑ > 1"

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/a to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"

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Date: I iS ,12002 Inspection by: Name: AP Agency: DEP Name: Agency: V NYC-WTC 000122689