WTC visual inspection form, 204 Broadway, 2002

NYC 9/11 Public Portal Document WTG viSuai Survey t orm Premise Address: 204 bP-OAD W AY Block: Residential 0 Commercial f Name of Building: Lot: Mix Usefl Other # of Stories: 2 AKA's: Building Owner/Management Telephone Number. (~tz ) 233— 96o Name: cou.eG t tu z ca t FAX: Address: 46 souN s ,r -wKc NY toOSS On Site Contact Name: v Av r> Telephone Number. .m ~z z 3 _ 1960 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 0 Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

visual Insoection Results: Facade: Inspected Debris North ❑ N/A ® Yes ❑ No j No Visible/Fine Layer ❑ Y2 to 1" 0>1*. South ❑ N/A ®'Yes ❑ No No Visible/Fine Layer D14to 1" 0>1* East ®N/A ❑ Yes ❑ No D No Visible/Fine Layer ❑%to 1" 0>1* West ❑ N/A f Yes ❑ No No Visible/Fine Layer ❑Y2to1" 0>1" Facade Description:

Roof " Debris: ❑ No Visible /Fine Layer J 14 to 1" D>1 Description: wrc yE13 s C r2 t) gm Roop- S e A/c Uhl 11'•S mm> OK\ 'r UE1 F~. P c f1 Ai6E5. fc''i 1 $K~i S l 3a f sr (M e.OP six s Setbacks N/A Floor Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" ❑ > 1" Debris: No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Floor. Floor. 0 Debris: No Visible/Fine Layer ❑ h to 1" Debris: ❑ No Visible/Fine Layer 014 to 1" 0>1* ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer h to 1" 0>10

I Comments

Date: = 002 Inspection Team: Name: _ ` D A / A o 2c7 Agency: NY c DAP Name: Agency:

NYC-WTC 000123285