WTC debris inspection form, 15 Gold Street, undated

NYC 9111 Public Portal Document

Premise Address: WTC Visual Survey Form 1025949 15 Gold 3+ree-~ Bloc Residential 0 Commercial JJ Name of Building: Lot: Mix Use Other # of to es: 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 0 Yes ❑ No Locations: Copies of All Reports and Data Requested jJ Yes

visual inspection Results: Facade: Inspected De ris North ❑ N/A ❑ Yes ❑ No tIIIo Visible/Fine Layer ❑%to1" 0>1" South ❑ N/A ❑ Yes ❑ No No VSible/Fine Layer ❑ % to 1" 0>1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑Yato1" 0>1" West ❑ N/A ❑ Yes ❑ No I]tJo Visible/Fine Layer ❑%to1 " 0>1" Facade Description:

Debris: 10 No Visible /Fine Layer 0 % to 1" ❑ > 1" Description:

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 ❑ h to 1" ❑ > 1" Comments

Date: /12002 Inspection by: Name: AP Agency: I )E P Name: Agency:

NYC-WTC 000128084