WTC debris inspection form, 113 Chambers Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: 1,1 Residential Block: Commercial D 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 D No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: . Inspected De ris o h ❑ N/A [ Yes ❑ No No Visible/Fine Layer ❑ % to 1" ❑ > 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/Fine Layer ❑ % to 1" [J> 1 Facade Description: pjYt V.r.~ ( nu 't t" `4i

Roof

Debris: Nb Visible /Fine , Byer ❑'/ to 1" '1 -~""" ❑ > 1" 1 Description:

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

Comments n n A A I

Date: 3/002 Inspection Team: Name: Agency: Name: Agency: ____

NYC-WTC 000122008