WTC visual inspection form, 204 Broadway, 2002

NYC 9/11 Public Portal Document w rc visual survey Form Premise Address: 204 BROADWAY Block: Residential 0 Commercial J Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Building Owner/Management Telephone Number ( 212) 233- 1960 Name: G, Ca ( FAX: Address: 45 Jo s sc i Te t000 law ~102+w is ra On Site Contact Name: * ' -D. Telephone Number. 2 i 233-1J6 o Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up Yes ❑ No Locations: ACM Clean Up D Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested 0 Yes

Visual Insoection Results: Facade: Inspected Debris ❑ N/A ®'Yes ❑ No ❑ A to 1" ❑ > V. North South East ❑ N/A N/A Q Yes ❑ No ❑ Yes ❑ No 0 No Visible/Fine Layer No Visible/Fine Layer ❑ No Visible/Fine Layer ❑ .4 to 1" ❑ h to 1" ❑ > 1' ❑ > 1" West ❑ N/A 1Z Yes ❑ No jo No Visible/Fine Layer ❑ h to 1" ❑ > 1" Facade Description:

Roof Debris: ❑ No Visible /Fine Layer ®h to 1' ❑ > 1" Description:

Setbacks N/A s Floor Debris: ❑ No Visible/Fine Layer ❑'6 to 1' 0)? Floor. Debris: No Visible/Fine Layer ❑ % to 1' > 1" Floor____ Debris: g No Visible/Fine Layer ❑ % to 1' > 1" Floor Debris: ❑ No Visible/Fine Layer 9 to V ❑ > 1' Floor. Debris: ❑ No Visible/Fine Layer ❑ 14 to 1' >1' Comments

I Date: _1 OS 12002 Inspection Team: Name: I A /-Acs 2O NY Agency: _, Name: Agency:

NYC-WTC 000123284