WTC building inspection form, residential or commercial, Jun 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form dB t 4- 1O0 i -z S Premise Address:

Block: 10 3FL Residential 4on `-, ree+ Commercial ~'~'~ Name of Building: Lot: C1 Mix Use f J Other # of Stories: 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 Kesuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer []vto1" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yatol" ❑>1" West ❑ N/A [] Yes [] No ❑ No Visible/Fine Layer 0114t01" .O>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer to 1" ❑ > 1" Description:

Setbacks N/A [] Floor. Debris: ❑ No Visible/Fine Layer ❑'/Z to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" O>1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑'/to 1" ❑ > 1"

Comments

Date: ~/ I /2002 Inspection by: Name: Cc.- Agency: OP Name: Agency:

NYC-WTC 000127867