Asbestos disposal documentation form, 2002

NYC 9/11 Public Portal Document

/" 1 WTC Visual Survey Form .7 Premise Address: L1 .

Block: Residential 0 Commercial J Name of Building: Lot: Mix Use 0 Other # of Stories: S 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 ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North © N/A [IYes ❑ No ❑ No Visible/Fine Layer % to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0114t01" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" [3>1" Facade Description: 1 nJ4 rt ri) hn,.14 - 1-Ci'

Roof

Debris: ❑ No Visible /Fine Layer [] ½ to 1" >1" Description: j bV s s _a..z) a-d .vt 1 tf ,l C4

Setbacks N/A S1 Floor. Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor. Debris: 0 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 0½ to 1" ❑ > 1"

Comments Nb AL L ('

Date: 1 ' /2002 Inspection Team: Name: - Agency: Name: r-t Agency: Az f11' NYC-WTC 000127339