WTC Facade Inspection Form, 100 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercial 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 J Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No [] No Visible/Fine Layer ❑ % to 1" ❑ > 1" oath " ❑ N/A P!~es ❑ No o Visible/Fine Layer ❑ % to 1" > 1" East ❑ N/A Yes ❑ No Q No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" O>1" Facade Description:

Roof

Debris: No Visible (Fine layer ❑ % to 1" •1 =~'"' ❑ > 1" "1 {"""~ Description:

Setbacks N/A ❑ Floor: Debris: 0 No Visible/Fine Layer ❑ 1 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 0 % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V to 1" ❑ > 1"

Comments

Date: / /2002 Inspection Team: Name: ______________________Agency: Name: Agency: ENTERED NYC-WTC_ 000122058