295 GREENWICH 1066187, 137/7502

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: q eE -r I Name of Building: Block: Residential p Commercial O Lot: I Mix Use ❑ Other ❑ 3t~1O•f Q p, e~MIk) ltd # of Stories: AKA's: Building Owner/Management: Telephone Number. I ) a, Name: - FAX: ( ) a Address: 5 On Site Contact: Name: Telephone Numl r. ( ) Building Owner Management tivities Interior Survey Performed [~] s ❑ No Exterior Survey Performed Yes ❑ No y'` A t4 C. General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring [.J d(es ❑ No Locations: Copies of All Reports and Data Requested O Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A El Yes O No ❑ No Visible/Fine Layer ❑ /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 ❑ Y2 to 1" ❑ > 1" West ❑ N/A ,❑ Yes ❑ No .E] No Visible/Fine Layer ❑ /2 to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑/2to1" >i" Description: C't 'P n ' o c.5 . & ra ve Ina I y' 1 v srrer

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ /z 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" ❑ > I"

Date: j I /2002 Inspection Team: Name: Name:

NYC-WTC 000134641