Asbestos Project Notification and Inspection Report, Dec 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential □ Commercial □ Name of Building: Lot: Mix Use □ Other □ # of Stories: A KA’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 □ INo □ No Visible/Fine Layer 014 to 1 ” □ > 1” South □ N/A □ Yes □ INo □ No Visible/Fine Layer □ 14 to 1 ” □ > 1” East West □N/A □ N/A □ Yes □ INo □ Yes □ INo □ No Visible/Fine Layer □ No Visible/Fine Layer □ 14 to 1 ” O >4 to 1 M □ > 1” □ >1” Facade Description:

Roof

Debris: □ No Visible /Fine Layer □ %tor □ >1” Description:

Setbacks N/A □ Floor: Debris: □ No Visible/Fine Layer □ 14 to 1” □ >1” Floor: Debris: □ No Visible/Fine Layer □ to 1 □ >1” Floor: Debris: □ No Visible/Fine Layer □ 14 to 1” □ >1” JJ Floor: Debris: □ No Visible/Fine Layer 014 to 1 □ >1” Floor: Debris: □ No Visible/Fine Layer □ 14 to 1” □ > 1” Comments

Date: //2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC_000149452