WTC debris inspection form for a building at 105 Chambers

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: 'O_c__ Residential 0 c,L Commercial - -< Name of Building: -t- Lot: Mix Use f J Other # of Stories S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: ~,,~ Name: /F Telephone Number Building Owner anagement Activities Interior Survey Performed Yes ❑ No ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._ Exterior Survey Performed (es ❑ No General Clean Up E4es ❑ No Locations: I" ACM Clean Up ❑ Yes o Locations: Air Monitoring ❑ Yes No Locations: Copies of All Reports and Data Requested Q Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ to 1" 1/ ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ 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 ❑ % to 1" ❑ > 1" Facade Description: , ' LL JJ2-rt

Roof

o Visible /Fine Layer ❑ Yz to 1" ❑ > 1" Debris: Description: ( ~~, y. - - Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % 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 ❑'/z to 1" ❑ > 1"

Date: 1/1/2002 Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000121956