WTC Facade Inspection Form, 170 Duane Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form remise Address:

Block: Residential 1 CommercialD Name of Building: Lot: Mix UseD Other # of Stories: 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 9 Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Insuection Results: Facade: Inspected Debris North /A ❑ Yes ❑ No O No Visible/Fine Layer Q / to 1" 0>1" South NIA YesD No o Visible/Fine Layer ❑%to1" 0>1" East N/A j] Yes 0 No O Visible/Fine Layer No ❑%:to1" 0>1" West /A []Yes❑No ❑ No Visible/Fine Layer ❑%atol" 0>1" Facade Description:

Roof Debris: Description: .V Visible /Fine Layer .934 to 1" ❑ > 1"

Setbacks N/A Floor Debris: No Visible/Fine Layer ❑ % to 1" ❑ >1' Floor. Debris: No Visible/Fine Layer ❑ h to 1" L]>1" Floor Debris: No Visible/Fine Layer h to 1" 0>1" Floor Debris: Q No Visible/Fine Layer % to 1" 9>1" Floor Debris: E] No Visible/Fine Layer A to 1" 0>1. Comments

Date:5i 1 /2002 Inspection Team: Name: L fr Agency: Name: Agency: E N T E R E 1'

NYC-WTC 000125771