WTC Debris Inspection Form for a building at 118 Chambers

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Add>r

Block: Residential fl Commercial D Name of Building: Lot: Mix Use ® Other # of Stories: AKA's: Building OwnerlManagement: Telephone Number: ( ) Name: L FAX:( Address: On Site Contact: Name: LLB' ll I C Telephone Number: 2 ) 27 t i Y- Building Owner Mahagement Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up [Yes ❑ No Locations: tJc ACM Clean Up Q 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 ❑'/Y to 1" Q > 1" South El N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer % 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" 0>1" Facade Description: -k

Roof

Debris: ❑ No yjisible /Fine Layer Q'/z to 1" Description:

Setbacks N/A ❑ Floor: Debris: 0 No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: o, / a /2002 Inspection Team: Name: Agency: Name: ___________________Agency: n OL

NYC-WTC 000121949