WTC exterior inspection form for 112-114 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: i2- CM — Block: Residential D Commercial 9 Name of Building: Lot: Mix Use Q Other # of Stories: AKA's: ii y 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 ❑ No ❑ No Visible/Fine Layer ❑'A2to 1" 0>1" South EN/A [Yes ❑ No ❑ No Visible/Fine Layer [a^/ to 1" D>1 East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2tol" 0>1" Facade Description:

Roof

Debris: E) No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description: I PLz'C-, f d~. I gs

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

Comments Mt .t(4'

Date: e'i / 6Zd /2002 Inspection Team: Name: #1L- Agency: Name: ____________________Agency: Da L i4

A ,M~y NYC-WTC 000121851