Asbestos inspection form, 102-104 Fulton Street

NYC 9111 Public Portal Document

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WTC Visual Survey Form 10 ®A 1 Q Premise Address: lOy ._ to Block: 7 Residential D Commercial 0 Name of Building: Lot: Y.,2 / Mix Use J Other # of Stori : 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 0 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 J Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ /2 to 1" E> 1" South D N/A ( 'es ❑ No ❑ No Visible/Fine Layer zto1" '0>1" East ❑ N/A ❑ es ❑ No ❑ No Visible/Fine Layer %to1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description: Fjys'hs. ccn:~~trws eEt

Roof E st; ' Debris: ❑ No Visible /Fine yer ❑ V to 1" ? ❑ > 1" Description:

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

Date: ,/ y/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000128681