WTC Facade Inspection Form, 102 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: cL-icL },- Block: Residential Commercial JJ Nam of Building: Lot: Mix Use 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 Q Yes No General Clean Up 0 Yes ❑ No Locations: B ACM Clean Up Q Yes 0 No Locations: Air Monitoring fl Yes ❑ No Locations: Copies of All Reports and Data RequestedD Yes

Visual Inspection Results: Facade: inspected Debris North 0 NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer 9 4 to 1' ❑ > 1" South ❑ N/A Q Yes ❑ No Q No Visible/Fine Layer ❑ % to 1' 0>1" East 0 N/A 0 Yes [] No ❑ No VSible/Fine Layer ❑'% to 1' ❑ > 1' West ❑ N/A 0 Ye j] No 0 No Visible/Fine Layer ❑ A to V j] > 1" Facade Description: ( I) - 6

Debris: =J No Visible /Fine Layer O % t 1" `' ' 9> 1' Description:

Setbacks N/A' Floor____ Debris:D No Visible/Fine Layer D4to 1' ❑ > 1' Floor. Debris: 0 No Visible/Fine Layer % to V [} > 1' Floor: Debris: No Visible/Fine Layer % to 1' j] > 1' Floor. Debris: No Visible/Fine Layer % to V > 1' Floor. Debris: ❑ No Visible/Fine Layer 0 3610 V 9> 1' Comments

Date: 1 3 1200,2 inspection Team: Name: Name: Agency: Agency:

NYC-WTC 000122067