Visual survey form, 112 Fulton Street, 2002

NYC 9111 Public Portal Document '

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WTC Visual Survpv Form t% I OO12 t O fu I+on cSfree Premise Address: c9 I 17 - 1 Du+ch S+r Block:18 Residential 0 Commercial J Name of Building: Lot: 4q Mix Use 0 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 ❑ Yes

visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Y2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Y2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer [[11 4t01" 0>1" Facade Description:

I Roof

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

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1" Floor. Debris: ❑ No ViSible/Fine Layer ❑ 1/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Comments

Date: c 1 / 1 7 12002 Inspection by: Name: AP Agency: DEP Name: Agency:

NYC-WTC 000128807