WTC visual inspection form, 204 Broadway, 2002

NYC 9/11 Public Portal Document

10012.22 10 WTC Visual Survey Form Premise Address: #3 o `T "Broa d uua L Block: Residential 0 Commercial Name of Building: Lot: Mix Use J Other # of S orl as: 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 Requested 1Yes Visual inspection Results: Facade: Inspected bris North ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑Yato1" 0>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑/to1" 0>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: No Visible /Fine Layer ❑ Y to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor. Debris: 0 No Visible/Fine Layer ❑'/s to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: / _15 /2002 Inspection by: Name: /VP Agency: DEP Name: Agency:

NYC-WTC 000123280