WTC facade inspection form, 110 Fulton Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form BN 100119 4 Premise Address: ) 1p ru

Ron S ree+ Block: ? S Residential 0 Commercial Name of Building: Lot: q Mix UseD Other # 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 ❑ 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 o Visible/Fine Layer ❑'h to l" 0>10 South ❑ N/A ❑ Yes ❑ No o Visible/Fine Layer ❑ a to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof

Debris: Visible /Fine Layer ❑ % to 1" D>1" Description:

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

Date: cO / . 7 12002 Inspection by: Name: P Agency: AEP Name: Agency:

NYC-WTC 000128697