WTC Debris Inspection Form, 105 Chambers Street, Oct 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: Q -I

Block: /J ç Residential Commercial Name of Building: Lot: Mix Use ❑ Other ❑ # of Stories: 5 AKA's: y7 7L/

Building Owner/M nagemen : Tel phone Number: ) Name: 4`JCL /-L FA)(:( ) Address: . l 1 On Site Contact: Name: A' Telephone Number: ( 9 ) , Building Owner fanagement Activities 5 — Interior Survey Performed 'Yes ❑ No Exterior Survey Performed El Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: 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 ❑'/Z to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer El 1/2 to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'h to 1" ❑ > 1" Facade Description: II jJ-cIs

Roof

Debris: N< o Visible /Fine Layer ❑'h to 1" ❑ > 1" Description: ,..r ~, _ ,

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

Comments

Date: / /2002 Inspection Team: Name: Ik Agency: ~L Name: w-( Agency: g NYC-WTC 000121961