Document label sheet, 5 Broadway area, Oct 2001

NYC 9/11 Public Portal Document

WTC Visual Survey Form PremiseAddress: - -- — L Block: I Res dential D Comh,ecial Name ofBuilding l _/OOOON Lf Lot: Mix Use El Other # of Stories: 'y AKA's: Building Owner/ anag ent: Telephone Number.) II Name: -- FAX: ( ) P Address: On Site Contact: Name: L 1 L..- v► t-o- . Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ['N Exterior Survey Performed ❑ Yes [ .No General Clean Up 4es ❑ No Locations: ACM Clean Up ❑ Yes o Locations: Air Monitoring ❑ Yest Locations: Copies of All Reports and Data Requested I J Yes

Visual Inspection Results: Facade: Inspected Debris North . N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" O>1" South -N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" O>1" East D N/A Yes ❑ No - No Visible/Fine Layer ❑Yto1" ❑>1" West n N/A Wes ❑ No E4No Visible/Fine Layer ❑ Y to 1" O>1" Facade DescriDtion:

Roof

Debris: o Visible /Fine Layer ❑ % to 1" •1 ~'"' ❑ > 1" 1 Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" [3> 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: t / ,j2002 Inspection Team: Name: '- Agency: ) C?~ Name: Agency:

NYC-WTC 000123510