WTC building inspection form, residential or commercial, Jun 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 123 FULTO S,12 SET Block: 91 Residential 0 Commercial J Name of Building: Lot: D Mix Use Other # of Stories: 4 AKA's: 46 ANu S1 -2 r Building Owner/Management: MC-a MT Telephone Number. (2. t2. ) 732 - Ts 53 Name: 2 t cu A (M > BSL- FAX: Address: 20 Q ESEY SST Nq t~~j On Site Contact BLA4 Supr II Name: Telephone Number P 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: ,11n;pected Debris North ❑ N/A Yes j] No ❑ No Visible/Fine to 1" E]>1". South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer to 1' ❑ > 1" East N/A Yes ❑ No ❑ No Visible/Fine Layer91~AA Layer to? ❑ > 1" West N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" O>1" Facade Des6ription: .ID~BSZI S ` ON W l P1DOW LEDGES ANb Ft Oe ESCA PP

Roof

Debris: []No Visible /Fine layer E V2 to? O>1' Description:

Setbacks N/AX Floor. Debris: [] No Visible/Fine Layer ❑ Va to 1" O>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ V2 to 1' ❑ >1" t Floor. Debris: 0 No Visible/Fine Layer ❑ Va to? ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Y to 1' [J>1" Floor Debris: ❑ No Visible/Fine Layer ❑ 2 to? O>1" Comments

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Date: / 11 /2002 Inspection Team: Name: )A /AO2o Agency: NYC vim► Name: Agency:

NYC-WTC 000127865