DEP Service Request Form, 295 Greenwich St, Feb 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: q S -r- Block: I Residential J Commercial 0 I Name of Building: Lot: I Mix UseD Other 0 t C-f Q . C MOUfl # of Stories: AKA's: Building Owner/Management Telephone Number. I . ) 54a Name: LLti& Cc99 - FAX: ( )

a

Address: On Site Contact Name: Telephone Number Building Owner Management dtivities Interior Survey Performed [ s ❑ No Exterior Survey Performed Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring Q'es ❑ No Locations: Copies of All Reports and Data Requested I Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ NIA 0 Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1" South ❑ NIA D Yes ❑ No 'D No Visible/Fine Layer ❑ Y2 to 1" 0>1" East ❑ N/A ❑,Yes ❑ No '.❑,No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A L] Yes ❑ No .❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1" Facade Description:

Roof

❑ Debris: Visible /Fine Layer ❑%to1" Q t.5 . .& ra vc P >1" h; n

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 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 ❑ % to 1" ❑ > 1"

Date: Inspection Team: Name: Name:

NYC-WTC 000134638