Visual survey form, 111 Fulton Street, Feb 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form 1007243 i 14c)n 5-Free+ Premise Address: j1 i Block: Residential 0 Commercial 0 Name of Building: Lot: I Mix Use Other # of Stories: AKA's: Building Owner/Management: Op L17 a onS. I14q311 1 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 ❑ % to 1" 0>1" South ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No No Visible/Fine Layer ❑ % to 1" 0>1" West ❑N/A Facade Description: ❑Yes❑No Po Visible/Fine Layer ❑ % to 1" ❑ > 1"

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

Setbacks N/A ❑ Floor Debris: ❑ No Visible/Fine Layer Ova to 1" ❑ > 1" 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 ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" f Comments

Date: )//2002 inspection by: Name: \P Agency: DEP Name: Agency:

NYC-WTC 000128765