WTC Debris Inspection Form for a building at 118 Chambers

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: -

Block: Residential Commercial 9 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 g No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ,Q Yes 9 No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North f1TA ❑ YesQNo 1_] No Visible/Fine Layer South O N/A 0 YesQNo ❑ No Visible/Fine Layer /s to 1' D>1 East West Q N/A B N/A Facade Description: ❑ Yes(] No ❑ YesQNo O No Visible/Fine O No Visible/Fine Layer Layer [] % to 1' ❑ 3h to 1' [] > 1" 9>V

Roof

Debris: D No Visible /Fine Layer 1%'to 1' - 0 >1 Description: A • w A C

Setbacks N/A9 Floor. Debris:D No Visible/Fine Layer 934 to 1' 02,10 Floor____ Debris: 9 No Visible/Fine Layer 936 to 1' 9> 1' Floor. Debris: 0 No Visible/Fine Layer 0% to 1' 0> 1' % to 1' Floor. Floor. Debris: 0 No Visible/Fine Layer Debris: ❑ No Visible/Fine Layer 9 4 to 1' > 1' > 1'

Comments

C

Date: l 12002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC-000121951