WTC facade inspection form, 78 Dutch Street, 2002

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise Address: _ ~'7 1-7I2 ~/2 D u -Fc h Sire e- F Block: 7 Residential 0 Commercial 0 Name of Building: Lot: 2(P Mix Use ❑ 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 Reqiiested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer / to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer %Z to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer z to 1" 0>1" Facade Description:

Roof

Debris: )(No Visible /Fine Layer E]Y to 1" 0>1" Description:

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

Date: c) / /2002 Inspection by: Name: (\P Agency: DGP Name: Agency:

NYC-WTC 000130787