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NYC 9111 Public Portal Document

WTC Visual Survey Form Premise Address: 24c v4ia Block: Residential Commercial Name of Building: Lot: Mix UseD Other A'a / £2m # of Stories: 3 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 Yes Visual inspection Results: Facade: Inspected Debris North J NIA ® Yes ❑ No ❑ No Visible/Fine Layer ❑'/sto l" 0>? South N/A EYes ❑ No ❑ No Visible/Fine Layer ❑%tol" 0>1" East N/A ® Yes ❑ No No Visible ❑%to1" 0>1" West 0 N/A ❑ Yes ❑ No No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Setbacks N/A Floor Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ a 10 1" ❑ > 1" Floor Floor. Debris: [] No Visible/Fine Layer Debris: ❑ No Visible/Fine Layer 8 h to 1" h to 1" H > 1" > 1" Comments

Date: 5- 10/ 12002 inspection Team: Name: R4 k7 Agency: .DEP Name: Agency: ENTEREQ

NYC-WTC 000123365