WTC debris inspection form for 192 Broadway, n.d.

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WTC Visual Survey Form Premise Address: JOIJN 9 A kA i 2 B2va~wA.~

Block: Residential 0 Commercial J J Name of,$u Idinn . Lot MixUseD Other - # of Stories: 8 AKA's: Building Owner/Management: c c -rE curet Telephone Number. (i -) 233- 11%0 Name: w-i + o rz.,-i NAR. FAX:( Address: 4s JoµN s-ri-r NEw Yoe v- m4y 4 0038 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 j1No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North 0 N/A ® Yes ❑ No ® No Visible/Fine Layer ❑%to 1" ❑>'I' South 0 N/A ® Yes ❑ No 0 No Visible/Fine Layer f j S to 1' 0>1' East ❑ N/A ® Yes ❑ No ® No Visible/Fine Layer Q h to 1 ' 0 >1' West 0 N/A f Yes o No ® No Visible/Fine Layer [] h to 1' 0>1' Facade Description:

Roof

Debris: J l No Visible /Fine Layer ❑'/to1' 0>1' Description:

Setbacks NWAE] Floor Debris: 0 No Visible/Fine Layer 0% to 1' 9>1' Floor Debris: 0 No Visible/Fine Layer ❑ % to 1' 0>1' Floor Debris: Q No Visible/Fine Layer ❑ % to 1' 0>1' Floor Debris: ❑ No Visible/Fine Layer 0 % to 1' 0>1' Floor.____ Debris: ❑ No Visible/Fine Layer ❑ f to 1' 0>1'

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Inspection Team: Name: t A / i02o Agency: _DE P Name: Agency

NYC-WTC 000123103