WTC Facade Inspection Form, 100 Chambers Street

NYC 9/11 Public Portal Document

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~/ I / WTC Visual Survey Form Premise Ad /

Block: sidential Commercial J Name of Building: Lot: Mix Use Other # of Stories: AKA's: Building Owner/Management: Telephone Number. (z, . ) 2 i z - '~ yo Name: 1 M, S kG GL• `~ FAX: (- ) z./ L - 7.3 y - / 1 Address: P11 On Site Contact: ?--- Name: Telephone Number: ( ) Building Owner Management Activities Interior Survey Performed ❑ Yes ❑ No S.r+ /"~'~'~r' !! ~"..r f , J 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 DYes

Visual Inspection Kesuits: Facade: Inspected Debris North ❑ N/A ® Yes ❑ No Q No Visible/Fine Layer D% to 1" 0>1" South © N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" East x N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/a to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine ayer ©'/: to 1" 7 '~'"'~ ❑ > 1" Description: Lt) • / ,4,_A' s [ t rri. ( .t i!/1nr1 / ., • (C 1L+ ~•. 1 ro r, ti APc % .! i'% ,c c . <'[..Ii /(f? 4," / . 1

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments /

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Name:

NYC-WTC 000122057