DEP Final Notice regarding WTC debris at 116 Chambers Street,

NYC 9/11 Public Portal Document

fTC Visual Survey Form Premise Address:

Block: Residential Commercial p Name of Building: Lot: Mix UseD 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 WA ❑ Yes ❑ No No Visible/Fine Layer to 1" ❑ > 1" South CAN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" []>I" West ❑ N/A [] Yes ❑ No ❑ No Visible/Fine Layer [] % to l" 0>1' Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer r]

% to 1" ' 0:.1" Description:

Setbacks NIA❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" 0>1. Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ 34 to 1" ❑ > 1' Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ y4 to 1" 0> 1" Comments

Date:'/ 7 12002 Inspection Team: Name: Agency: _____ Name: Agency:

NYC-WTC 000121916