WTC debris inspection form, undated

NYC 9/11 Public Portal Document

L 1079 2.I' WTC Visual Survey Form Premise Add :

Block: Residential Commercial Name of Building: Lot: Mix Use Other # of Stories: AKA's: Building Owner/Management: Telephone Number ( ) Name: rr FAX: Address: b On Site Contact: V j 5t t 441'/. 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 ❑ Yes ❑ No ❑ No Visible/Fine Layer 036t01" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" Facade Description:

Roof

Debris: W No Visible ❑%to1" 0>1" Description: L j

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 034 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0> 1" Comments

Date: , j- i f~2 Inspection by: Name: t _L . Agency: Name: Agency:

NYC-WTC 000127914