WTC facade inspection form, 15 Dutch Street, Oct 2001

NYC 9/11 Public Portal Document WTC Visual Survey Form Premise Address: a ,{

Block: Residen laiD CornrnerciatJ Name of Building: Lot Mix LlselJ Other g of Stories: AKA's: Building Owner/Management Telephone Number. ( ) Name: F FAX: Address: On Site- Contact: Name: " '" Telephone Number. Building Owner Management Activities Interior Survey Performed Yes Q No Exterior Survey Performed Yes No General Clean Up Yes No Locations: ACM Clean Up L] Yes No Locations: Air Monitoring D YesL]No Locations: Copies of All Reports and Data Requested DYes

Visual Inspection Results: Facade: Inspected . Debris North D N/A Yes No No Visible/Fine Layer % to 1 > 9' South [] N/A Yes No No Visible/Fine Layer % to V > 1' East N/A - No i~lo Visible/Fine Layer to 1' >1' West N/A Yes No No Visible/Fine Layer 'K to 1' > 1'

Debris: L] No Visible /Fine Layer j[]%to1'. D>1 ' Description:

Setbacks WAD Floor_ . Debris: No Visible/Fine Layer y4 to 1' >1' Floor_ Debris: No Visible/Fine Layer 'K to1' > 1' Floor.___ Debris: No Visible/Fine Layer %to 1' > 1' Floor_ Debris: No Visible/Fine Layer 34 to 1' > 1' Floor.___ Debris: No Visible/Fine Layer '4 to1' > 1' Comments

Inspection Team: Name: Agency: dame: Agency: ENTERE

NYC-WTC 000130831