WTC debris inspection form, 143 Fulton Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Pemise Address:

Block: Residential Commercial am of Bu1c! : Lot: Mix Use . Other ,. t # 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 to General Clean Up S(es ❑ No Locations: ACM Clean Up DYesJNo Locations: Air Monitoring ❑ YesJ 10 Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A es ❑•No -2"o Visible/Fine Layer ❑ 34 to 1" ❑ > 1" East ❑ N/A Fyyes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer to 1" 0>1" Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ t/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Comments II r I~ a

Date:'/ /2002 Inspection by: Name: (_ kitL. Agency: Name: Agency:

NYC-WTC 000128074