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

NYC 9/11 Public Portal Document

. 4

WTC Visual Survey Form Ic~C>l2tS Premise Address: y_ n

Block: ~j 9—I l Residential D Orrree-I- / Commercial 0 1a Name of Building: Broathaq Lot: I Mix UseEl OtherI J # 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 Q Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes Q No Locations: Copies of All Reports and Data Requested j J Yes

visual inspection Results: Facade: Inspected North ❑ N/A ❑ Yes ❑ No Visible/Fine Layer ❑%to1" 0>1" South ❑ N/A ' Q Yes ❑ No Visible/Fine Layer ❑%to l" 0>1" East Q N/A Q Yes ❑ No r Visible/Fine Layer ❑ %to 1" 0>1" West Q N/A ❑ Yes ❑ No Visible/Fine Layer ❑Y2tol" 0>1" Facade Description:

Roof Debris: Visible /Fine Layer Q Va to 1" 0>1" Description:

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer 0S4 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 034 to 1" ❑ > 1" Floor. Debris: Q No Visible/Fine Layer D3 to 1" 0> 1" Floor Debris: Q No Visible/Fine Layer ❑% to 1" ❑ > 1" Comments

Date: 2i I /200 Inspection by: Name: 1W Agency: DEP Name: Agency:

NYC-WTC-000123105