Asbestos inspection form, 15 Dutch Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form (Don q-7_ Premise Address: ' Du+ch S-Free-F- Block: 7 B Residential Commercial Name of Building: Lot: -7 SC'+ 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 Requested ❑ Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ' 0 1" [2> 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" [2 > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" [2 >1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0'/ to 1" [2 >1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑'/to1" ❑>1" Description:

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

Date: / 1 7 /2002 Inspection by: Name: Name: /a P Agency: Agency: DEP

NYC-WTC 000130832