WTC Facade Inspection Form, 99 Chambers Street

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise Address: C: -

Block: Residential D Commercial D Name of Building: Lot: Mix Use Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: 1 Name: Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑Yes ❑ No 7 Exterior Survey Performed ❑ Yes ❑ No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes Q No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested EYes

visual Inspection KesuIiS: Facade: Inspected Debris North N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" South ❑ N/A Yes ❑ No No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" East 0 N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Q'/ to 1" ❑ > 1" West O N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer Q'/ to 1" 0>1" Facade Description:

~ i'' ~', Yom% fr✓•~ 1 ? l (,nrHh~f, ' /. (o__ f_ f /~~ 1 \ Roof

Debris: ❑ No Visible /Fine yer ❑'/a to 1" •1 -{'~' ❑ > 1" / Description:

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer ❑ v to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/s to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"

Comments C...,• C t N. ? ~ 1.1 ~ ~ 11 r ~r•~ S.

Date: / ! a /2002 Inspection Team: Name: K. ('u 12,+nT < It Agency: L' 3 t' Name: IL / /in "9"- Agency: / -rc 06P 31

NYC-WTC 000122049