295 GREENWICH 1066187, 137/7502

NYC 9/11 Public Portal Document

.' I WTC Visual Survey Form Premise Address:

Block: Residential J Commercial 0 I ame of Building: Lot:WO,;Z, I Mix Use ❑ Other ❑ ~U-eoacLi Cbt2 p• e.~Mlk) l ff1 # of Stories: AKA's: Building Owner/Management: Telephone Number. I ) 5g Name: A i t- FAX: ( ) Address: 5 On Site Contact: Name: Telephone Number. ( ) Building Owner Management 6tivities Interior Survey Performed 1' s ❑ No Exterior Survey Performed Yes ❑ No y'` A t4 General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring [.'es ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A 121 Yes ❑ No ❑ No Visible/Fine Layer [J 1/2 to 1" ❑ > 1" South ❑ N/A ❑..Yes ❑ No ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" East ❑ N/A ❑Yes ❑ No '.❑,No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" West' ❑ N/A ,❑ Yes ❑ No .❑ No Visible/Fine Layer ❑ /2 to 1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑ /2 to 1" >,1" Description: C^'~ ~~ r. t~1~~ t. ~~ rt~?~G + Q S:S • .& ft< ve b; I

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

Date: /12002 Inspection Team: Name: 0 Agency: Name: D Agency:ks t?j4

NYC-WTC 000134641