WTC building inspection form, residential or commercial, Jun 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 123 FU 1 T O tJ S -T1?'T Block: 91 Residential 0 Commercial 0 Name of Building: Lot: S Mix Use Other # of Stories: Q AKA's: 46 A, Sssa'r Building Owner/Management cc -ma. MG MT Telephone Number. (a- ra. ) `732 —16 S3 Name: e1 cu A ~i FAX: Address: 20 ves S ~i- Nq NY On site Contact: BLDEe suer Name: LAN Telephone Number! Building Owner Management Activities Interior Survey Performed Q Yes ❑ No Exterior Survey Performed Q Yes Q No General Clean Up ❑ Yes Q No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring Q Yes Q No Locations: Copies of All Reports and Data Requested Yes

visual inspection Kesullts: Facade: to pected Debris North Q N/A ,Yes Q No Q No Visible/Fine % to 1" ❑ > 1"• South ❑ N/A Yes Q No ❑ No Visible/Fine Layer Layerfl/2 to i" ❑ > 1" East J NIA Yes Q No ❑ No Visible/Fine Layer / to 1" ❑ > 1" West N/A ❑ Yes Q No Q No Visible/Fine Layer QY to 1" O>1" Facade Des ription: D tS ON Wip.tXLO tEDCES A't1D R tzc ESOP '

Roof

Debris: Q No Visible /Fine Layer td'/: to 1" O> 1" Description:

Setbacks N/Ag Floor. Debris: 0 No Visible/Fine Layer 034 to 1" ❑ > 1" Floor. Debris: Q No Visible/Fine Layer ❑'/ to 1" O>1" Floor. Debris: Q No Visible/Fine Layer ❑ 4 to 1" [1> 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" O> 1" Floor Debris: [1No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

I Comments

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Date: J ti /2002 Inspection Team: Name: J)A /AO Zo Agency: ate DQ1 Name: Agency:

NYC-WTC 000127866