WTC Facade Inspection Form, 102 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:' e Block: j2, Residentia)D Commercial D Name of Building: Lot: Mix Use Other # of Stories: t AKA's: fr 51 Teleph S t.umbe : ur4 ) FJ_ Building Owne anagement: -

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 [] Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No Q No Visible/Fine Layer Q Vz to 1" ❑ > 1" South [] N/A RYes ❑ No ❑ No Visible/Fine Layer to 1" ❑ > 1" East Z,N/A Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West Eg N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > I" Facade Descoptian: o , i 0 Pr r c ,vi4lA 0AJ

Roof

Debris: No Visiblg,/Fi yer '/2 to fi" >1 1

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

Date: I !V/2002 Inspection Team: Name, Name:

NYC-WTC 000122086