DEP letter requesting environmental data for 115 Chambers Street, Feb

NYC 9/11 Public Portal Document

WT( Visual Survey Form Premise Address: t . Name of Building: 3 Block: /1/ .. Residential f Commercial Mix Use ❑ Other kG Lot: # of Stories: AKA's: Building O n / nagement: Telephone Number: (yt Z) < /j 7 Name: IxXjk Q.L2 FAX: ( ) Address: On Site Co, ct: ' , Name: ~ -2 Telephone Number: ( ~, — I 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 ❑'/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 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" [2 >i" Facade Description: I I 0 n n n n

I Roof Debris: "~IQoVisible /Fine Layer ❑'/2 to 1" [2 >1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Ys to 1" [2 >1" Floor: Debris: ❑ No Visible/Fine Layer ❑ YZ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" [2 >1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments nn

Date: ( / /2002 Inspection Team: Name: v _ 7 .L ._ Agency: ~' C fE Name: Agency: t S t oL

NYC-WTC 000121880