WTC exterior inspection form for 115 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ~+ t s `ter Block: Residential Commercial Name of Building: Lot: # of Stories: Mix Use O Other O AKA's: C.. 7 Building O ne;/ nagement: Telephone Number: Name: 9E2 FAX:( ) P Address: -~ - On Site Co ct: Name: cx_S Building Owner Management Activities .C Telephone Number: P11 ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._ Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up ( 'Yes ❑ No Locations: ACM Clean Up ❑ Yes ENo Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested [ 1 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2 to 1" O>1" East ❑ N/A ❑ Yes ❑ No O No Visible/Fine Layer ❑'/2to1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" O>1" Facade Description:

Roof

Debris: Visible /Fine Layer ❑'h to 1" ❑ > 1" Description:

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

Comments

Date: ( ! /2002 Inspection Team: Name: , Agency: Name: Agency:

NYC-WTC 000121876