WTC Facade Inspection Form, 102 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form 10 f ., - Premise Address:

Block: Resident Commercial D I Name of Building: Lot: Mix Use Other # of Stories: Building AKA's: !ri 3- (1 OwneflManagement: Yfl cS3-} flc/ / 5 1( 1- u Teleph id tiu be : ) rch 9- 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" '/2 ❑ > 1" South ❑ N/A Yes ❑ No ❑ No Visible/Fine Layer W2 to 1" ❑ > 1" East ZN/A Yes ❑ No ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1" West SN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Facade Descgptign: -- tr..'. . -A ; JA 40 aAN i 0 P"DA r, n~u OAJ

Roof C

Debris: Visibg/Fi ayer ) J/2 to f . ='"'~ 4J > 1" 1 c Description:

Setbacks N/A Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"

Date: I 1 /2002 Inspection Team: Name, cy: ~r. Name:

NYC-WTC 000122068