WTC building inspection form, 42 Broadway

NYC 9/11 Public Portal Document

WTC Visual Survey Form Innnh12 7 r Premise Address: Bloc2. HO Broadwaq

Residentialp Commerciar1J Name of Building: -

Lot: ,., Mix Use Other # of stories' AKA's: ;, ,

Building Owner/Management: elepho umber: 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 j J Yes visual insuectton Results: Facade: Inspected De rs

Y North ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑'h to l" 0>1" South ❑ N/A ❑ Yes ❑ No NiNa Visible/Fine Layer ❑tot" ❑>1" East ❑ N/A ❑ Yes ❑ No Nio' Visible/Fine Layer ❑%to1" 0>1" West ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof Debris: Visible /Fine Layer 936t01" 0>1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer 034 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ 34t0 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ %: to 1" ❑ > 1" Floor. Debris: [] No Visible/Fine Layer ❑'/Z to 1" ❑ > 1" Comments

Date: )/g9 [_/2002 Inspection by: Name: A►P Agency: DE P Name: Agency:

NYC-WTC 000123613