WTC exterior inspection form for 112-114 Chambers Street

NYC 9/11 Public Portal Document

,/r WTC Visual Survey Form Premise Address: 1 1 L1 Block: Residential 0 Commercial D Name of Building: Lot: Mix Use 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 ❑ 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 ❑%to 1" D>1 South East West ❑ N/A ❑ N/A ❑ N/A E] Yes ❑ No Yes ❑ No ❑ Yes ❑ No ❑ No Visible/Fine Layer %to1" ❑ No Visible/Fine Layer ❑'/ to 1" ❑ No Visible/Fine Layer ❑'/ to 1" 0>1" 0>1" 0>1" Facade Description:

Roof

Debris: E No Visible /Fine Layer '/to1" 0>1" Description: /t -t

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 ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1"

Comments

Date: oi / bL 6 /2002 Inspection Team: Name: Agency: Name: __________________Agency: Oat_ A W 27 NYC-WTC 000121853