WTC debris inspection form for 116 Chambers Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: H, LH 4 Block: Residential LI Commercial j J Name of Building: Lot: Mix Use J 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" ❑ > 1" South J N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Q % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: 0 No Visible /Fine Layer .J % to 1 - ❑ > 1" Description: ( PEA- r2

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer fl 1/2 to 1" ❑ > 1" Comments

Date: c-, / / A6 /2002 Inspection Team: Name: AC Agency: Name: 1-/rR ~c ry Agency: tt ©L A 2 iii, NYC-WTC 000121905