WTC exterior inspection form for 115 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form 7 Premise Address: ~~ 5 Block: Residential Commercial Name of Building: Lot: Mix Use Other ❑ G .J # of Stories: AKA's: Building O n 1 nagement: Telephone Number: P II Name: FAX: ( ) Address: On Site Co ct: P II Name: O-r o._$ -Q, 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 ❑ Y2 to 1" O>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ '/2 to 1" O>1" Facade Description: e n n n

I Roof Debris: Visible /Fine Layer ❑ % 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 ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments nn

Date: ( / /2002 inspection Team: Name: o -- L .Agency: €f Name: Mt. Agency: 5t L o NYC-WTC 000121877