WTC building inspection form, 3-story residential building

NYC 9/11 Public Portal Document

r WTC Visual Survey Form Premise Address: C t 10" Block: Residential 0 Commercial Name of Building: Lot: Mix Use ❑ Other # of Stories: 3 , AKA's: Building Owner/Management: Telephone Number: ( ) Name: l- ° ~ FAX: Address: On Site Contact: Name: " * Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No —Z _ 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%to1" 0>1" South ❑ N/A IYes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 1 >1" East N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" >1" West En -N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer DY2 to 1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1" > 1" Description: c& Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 V to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"

Comments a\

Date: ~/ _12002 Inspection Team: Name: Agency: u Name: Agency:

NYC-WTC 000134098