WTC exterior inspection form for 122 Fulton Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 22 t' k 4-o ~•- Block: Residential 0 Commercial Name of Building: Lot: Mix UseD Other # of Stories: 6 AKA's: Building Owner/Management: Telephone Number. ( ) Name: FAX: Address: On Site Contact: Y .~ •, w- Name: " t1° (' 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: Inpected De)rls North ❑ N/A esDNo o Visible/Fine Layer ❑ % to 1" Q>1" South ❑ N/A 4J Yes 0 No Q No Visible/Fine Layer QV to 1" 0>1" East ❑ N/A [] Yes ❑ No ❑ No Visible/Fine Layer ❑ Va to 1" 0>1" West ❑N/A ❑YesDNo ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

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

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

Comments

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Date: 12002 Inspection Team: Name: Agency: Name: Agency: ENTERED

NYC-WTC 000129002