WTC debris inspection form for a building at 105 Chambers

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: Block: oc

Residential El Commercial -c' f- Name of Building: Lot: Mix Use EJ Other #of Stories: 3 AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: /F Telephone Number: (?1)) Building Owner Management Activities z ....U; Interior Survey Performed es ❑ No Exterior Survey Performed es ❑ No General Clean Up E4es ❑ No Locations: I" ACM Clean Up ❑ Yes Jo 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 ❑ 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 ❑'h to 1" ❑ > 1" Facade Description: ! LL IJL JJ-rtc

Roof

Debris: 1Visible /Fine Layer ❑ Y2 to 1" ❑ > 1" Description: — A _

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Ys to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

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

NYC-WTC 000121956