WTC debris inspection form, 113 Chambers Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: -,

Block: Residential Commercial El Name of Building: Lot: Mix Use 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 El Yes

Visual Inspection Kesuits:

Inspected Debris North N/A 0 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 ❑ Y2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ to l" 0>1" Facade Description:

! f Y i C i> F7 *,A 5 i! L-[ t,

Debris: ❑' No Visible /Fine Layer _ ❑'/z to 1" ❑ > 1" Description: 1 r, -4 E c

Setbacks N/A ( 1 Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ 14 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No VSible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

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Name: /- I C-,: Agency: i ~2

NYC-WTC 000122007