Asbestos bulk sample chain of custody form, 16 Warren Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ,2 Block: Residential El Commercial Name of Building: Lot: Mix Use j J Other ❑ # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: ro Name: ' ,r, Telephone Number: (2,,. ) 6 oY- 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 ❑ No ❑ No Visible Visible/Fjpa.Lavr ❑ /z to 1" ❑ > 1" South ❑ N/A ©Yes ❑ No ® Visible/ ine Lae El to 1" No ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A [1 Yes ❑ No ❑ No Visible/Fine Layer ❑ /s to 1" ❑ > 1" Facade Description:

Roof "/ Debris: No Visible ine aye El 1/2 to 1" 0> 1" Description:

Setbacks N/A [Da Floor: Debris: ❑ No Visible/Fine Layer ❑'h 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" Floor: Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"

Comments 1 ~1r~1w('fi(

o at e4cA1 G (C

Date: /1/2002 Inspection Team: Name: lei P+L h(r''c. I( Agency: US CP Name: 1. TtPp J o t f Agency: NKC nip

NYC-WTC-000112676