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← Document results/DEP Box 49/110 CHAMBERS STREET 1001486, 136/27
Document / 2 pages

WTC debris inspection form, 110 Chambers Street, 2002

Machine-extracted title · confidence 90%

Blank DEP form for recording facade and setback inspection results for foreign material debris at 110 Chambers Street.

NYC-WTC_000121976–000121977

Folder label: “110 CHAMBERS STREET 1001486, 136/27”

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Scanned page image, NYC-WTC_000121976
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NYC 9/11 Public Portal Document

WTC Visual Survey Form (S0 Premise Address: a i o L Block: Residential Commercial Name of Building: Lot: Mix Use D Other # of Stories: AKA's: 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 J Yes

Visual inspection Kesuits: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1' South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" [J> 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer E]'/2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" 0>1" Facade Description:

Roof u Debris: ❑ No Visible /Fine yer ❑ Y to 1" •1 'L,,v4 0>1" ' 4,14 Description:

Setbacks N/A ❑ 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 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments A- -

73 Date: /_/2002 Inspection Team: Name: "~~-- Agency: Name: Agency:

NYC-WTC 000121976

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NYC-WTC_000121976Source: NYC Law Department, mirrored locally

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