WTC Debris Inspection Form for a building at 105 Chambers

NYC 9/11 Public Portal Document

1

WTC Visual Survey Form Premise Address:

Block: R side tial D Commercial I 1 Name of Building: Lot: Mix Use Other # of Stories: AKA's: ioç 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 ❑ 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 El Yes

Visual inspection Kesuits: Facade: Inspected Debris North 0 N/A 0 Yes ❑ No ❑ No Visible/Fine Layer [:]v2 to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑v2to1" ❑>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y2 to 1" 0>1" Facade Descriptiop: -;f

Roof

Debris: 0 No Visible /Fine Layer ❑ !2 to 1" ❑ > 1" Description:

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 ❑ l2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: Of / ,2 6 /2002 Inspection Team: Name: ~L Agency: Name: Ho t2; o1.f Agency: Do.

NYC-WTC 000121963