Chain of custody form for asbestos samples, 33 Liberty Street

NYC 9/11 Public Portal Document

10o % i 2.q WTC Visual Survey Form Prerriina Address: ~ 4 5 lei Lace. Block: Residential D Commercial J Name of Building: Lot:I Mix Use Other F-DERAL 9-EseRvG ANNEX # of Stories: AKA's: Building Owner/Management: FE CAL 1ZCS Rvc- Pvvkrelephone Number: ( 212) '72o - 5S /3 Name: co FAX: Address: On Site Contact: &4. . En~r Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up 0 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring J~Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual inspection KeSuits: Facade: Inspected Debris North ❑ N/A 'Yes ❑ No ff No Visible/Fine-Layer ❑'/z to 1" ❑ > 1" South ❑ N/A ®'Yes ❑ No No Visible/F-iRe-Eayer []% to 1" ❑ > 1" East ® N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West [Y3 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer 0'/z to 1" ❑ > 1" Description: (y pie-] goof . 1~1,-,-I r,, x -4 wig ~• ~

Setbacks N/A ✓ Floor. ". Debris: ® No Visible/Fine Layer [ '/s to 1" ❑ > 1" Floor: Debris: ❑ No ViSible/Fine Layer ❑'/z 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"

Comments

Date: 2 /x/2002 Inspection Team: Name: Agency: 0 F P Name: Agency:

NYC-WTC 000093385