WTC debris inspection form for a building at 105 Chambers

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: , /' 0 Block: Residential j Commercial Name of Building: Lot: Mix Use IJ Other # of Stones S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: ( ) Address: On Site Contact: ~,,, Name: ' Telephone Number. I I Building Owner Management Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed D Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: I" 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 ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" O>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2 to 1" O>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2to l" O>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2 to 1" O>1" Facade Description: , cS

I Roof Debris: [ JO Visible /Fine Layer ❑%to1" ❑>1" Description: - ,.r _ ,, ,,

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

Date: I/ /2002 Inspection Team: Name: 1k-I ; Agency: Name: - Agency: N S 4 c O NYC-WTC 000121957