DEP letter requesting environmental assessment data

NYC 9/11 Public Portal Document

S~ 1 13Co Premise A dress: t WTC Visual Survey Form

Block:4 f i (,o Residential 0 1 *V- Commercial Name — of V1 ' 1 `l Building: 15` Lot: 1 Mix Use JJ Other # of Stories: AKA's: i Vt •t • Building Owner/Management Teleph&ie Number. ( ) $ Name: FAX: Address: On Site Contact Name: ' ' Telephone Number. Building Owner Management Activities Interior Survey Performed Q Yes [] No Exterior Survey Performed Yes Q No General Clean Up D Yes No Locations: ACM Clean Up DYes No Locations: Air Monitoring Q Yes Q No Locations: Copies of All Reports and Data Requested ❑ Yes

Visual Inspection Results: Facade: North N/A rlsoVisible/Fine Layer t] 34 to 1' fl )? South N/A o Visible/Fine Layer 0%to1' ci>r East 0 N/A o Visible/Fine Layer %tot' >1' West ❑ N/A j o Visible/Fine Layer htol' ❑>1' Facade Description:

Roof Debris: i No Visible /Fine Layer Q 34 to 1 0>? Description: -

Setbacks N/A Q Floor: Debris: No Visible/Fine Layer L]3411' >1' Floor____ Debris: No Visible/Fine Layer 4 to V > 1' Floor. Debris: No Visible/Fine Layer 34 to? >1' Floor.____ Debris: No Visible/Fine Layer 3% to? > 1' Floor. Debris: No Visible/Fine Layer 34 to? >1' Comments

[1M Inspection Team: Name: _ v / Agency: Name: Agency: ENTERED

NYC-WTC 000129050