WTC facade inspection form, 147 Duane Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form 100 I(olO premise Address:

Block: Residential 0 Commercial 0 Name of Building: Lot: Mix Use . Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: S // ss~ Name: C t i i - S t telephone Plumber. 212) 2 77 Building Owner Management Activities Interior Survey Performed ❑ Yes 0 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 It Facade: Inspected Debris North ❑ N/A (@Yes ❑ No No Visible/ er ❑ % to 1" 0>1" South ❑ N/A Yes ❑ No No Visible/ er ❑ % to 1" 0>1" East E N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Y to 1" ❑> 1" West ® N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0> 1" Facade Description:

Roof

Debris: g No Visible /f r ❑ % to 1" 0>1" Description:

Setbacks N/AJ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: [] No Visible/Fine Layer ❑ f to 1" ❑ > 1" Comments

Date: . l ll 12f Q2n Inspection by: Name: R Gt r» /rm h Agency: P Name: Agency:

NYC-WTC 000126037