WTC debris inspection form, 110 Chambers Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form(L` ) !'rarr+ise Address:

Block: r Residential D Commercial J s /— 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 Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fl r _❑ % to 1" ❑ > 1" Facade Description: ( c

Roof Est Debris: ❑ No Visible /Fine'Layer ❑ % to 1" •1 =~"' A ❑ > 1" 1 Description:

Setbacks N/Ac Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ /2 to 1" ❑ > 1"

Comments

Date: ?/ Inspection Team: Name: ~-N---- Agency: Name: Agency:

NYC-WTC 000121980