WTC Facade Inspection Form, 102 Chambers Street

NYC 9/11 Public Portal Document

10 ck44ko rY WTC Visual Surve Form Premise Address'

Block: Residential U Commercial 0 Name of Building: Lot: Mix Use Other # of Stories: AKA's: e.,~~ 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 Q No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North f N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South [] N/A [ f Yes ❑ No (Z No Visible ff '/2 to 1" ❑ > 1" East N/A ❑ Yes ❑ No ❑ No Visible/Fine La er ❑ Y% to 1" ❑ > I" West ] N/A Yes ❑ No (~ No Visibl Fne Layer Vg Y to 1" ❑ > 1" Facade Description:

Roof

Debris: No Visible Fine ay ❑ Yz to 1" 4 ={'"' ❑ > 1" Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ 4 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Ya to 1" ❑ > 1"

Comments -"R

Date: / 8'1 /2002 Inspection Team: Name: Q. Fift ,2 f f t' U Agency: V'S OrAq Name: P ~-/~~n ~Gl s ~y Agency: -C D£-

NYC-WTC 000122066