WTC Facade Inspection Form, 102-104 Fulton Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form t o 0$ tQ Premise Address: ,~/

Block: Residential p Commercial Name of Building: Lot: ,,2 / Mix Use 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 ❑ 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 f 1Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" South [] N/A 1'es ❑ No ❑ No Visible/Fine Layer /z to 1" '❑ > 1" East ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer QY2 to 1" ❑ > 1" West ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer ❑ Ya to 1" 0>1" Facade Description: .. )WT ,. sic

Roof Wst; Debris: ❑ No Visible /Fine yer ❑ h to 1" 1 0> 1" I A-44 ' Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1"

Date: / t-12002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000128684