WTC facade inspection form, 15 Cliff Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: / CL lcT STkF...ET Block: Residential J Commercial D Name of Building: Lot: Mix Use D Other j ,'V u Do /1 # of Stories: AKA's: Building Owner/Management ,e-Cp v jelephone Number. ( ~1Ij7 ) 7~t Name: (Q rnd FAX: Address: On Site Contact: c '-- / Name: Telephone Number: Building Owner Manageme t Acti sties Interior Survey Performed 0 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 D Yes

Visual inspection Results: Facade: Inspected Debris North ❑ N/A ®`Yes No RNo Visible r~ O % to 1" 0>1" South ❑N/A ®Yes❑No ®'No Visible D 4 to 1" 0>1" East ❑ N/A GYes ❑ No ®'No Visible/F er ❑ % to 1" 0>10 West ❑ N/A 'Yes ❑ No No Visible r D%to 1" 0>1" Facade Description:

Roof Debris: Jallo Visible r ❑34to1" 9>1" Description:

Setbacks N/A, Floor. Debris: No Visible/Fine Layer 9 % to 1" 9>10 Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer 9% to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 9Sh to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 9> 1" Comments

Date: / a I ~s 12002 Inspection Team: Name: R , RAMA- o //4W Agency: C.-PE; Name: Agency: ji NT ER :

NYC-WTC 000126446