WTC debris inspection form, 110 Chambers Street, 2002

NYC 9/11 Public Portal Document

F Premise Address: WTC Visual Survey Form 1.t o -- V Block: tvJ Residential CommercialD Name of Building: Lot: Mix UseD Other # of Stories: AKA's: - i Pt, d Building Owner/M nagement: Telephone Number: ( ) Name: 1 0C L.L C— o" c Z FAX: Address: i— On Site Contact: Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up Q Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring 0 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 %tot" ❑>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Y:to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑34to 1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer " Ito 1" ❑> 1" Description:

Setbacks N/A Q Floor. Debris: 0 No Visible/Fine Layer 0 S4 to 1" 0>1' Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: 8 No Visible/Fine Layer 0 A to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ 6 to 1" ❑ > 1' Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: / -1'4/2002 Inspection Team: Name: ______________________Agency: k Name: Agency: tENT

NYC-WTC 000121975