WTC exterior inspection form for 112-114 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential Commercial I 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 0 Yes ❑ No Locations: Air Monitoring ❑ Yes Q No Locations: Copies of All Reports and Data Requested P Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Q Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to 1" 0>1" ti ❑ N/A (des ❑ No Q No Visible/Fine Layer Q'/2 to 1" >1" East ❑ N/A 0 Yes Q No Q No Visible/Fine Layer ❑%to 1" ❑> 1- West ❑ N/A Q Yes ❑ No Q No Visible/Fine Layer E]%2 to 1" 0>1" C9P7ric riner rir+inn-

ROOT

Debris: Visible /Fine ayer Ova to 1" •1 -~'"' ❑ > 1" 1 •i "' Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer 0% to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 Y2 to 1" Q > 1" Floor: Debris: Q No Visible/Fine Layer Q'/ to 1" ❑ > 1" Floor: Debris: []No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments

Date: /_ 12002 Inspection Team: Name: Agency: Name: Agency:

ENTERED NYC-WTC 000121861