WTC exterior inspection form for 114 Chambers Street, July 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: AKA'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 Q 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 Q N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1" ut ❑ N/A fes ❑ No ❑ No Visible/Fine Layer ❑Mato 1" - 1" East ❑ N/A Q YYes ❑ No ❑ No Visible/Fine Layer Q % to 1" 0>1" 1- West ❑ N/A ❑ Yes Q No ❑ No Visible/Fine Layer E)%: to 1" E>1" Facade Description: cr

Roof ~0sr 4.. Debris: Io Visible /Fine tayer nY. to 1".I :t.M 0>1" 1 • Description:

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" Q > 1" Comments

Date: / /2002 Inspection Team: Name: " Agency: Name: Agency: ENTERED NYC-WTC 000121822