Asbestos Inspection Results Form, 95 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise C L Address:

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Block: Residential Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: AKA's: Buildin wner/Man ement: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: - ' Telephone Number: Building OwnerManagement Activities Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed Q Yes t] No General Clean Up ACM Clean Up Air Monitoring 3 Yes No Locations: Yes 0 No Locations: 9 YesD No Locations: Copies of All Reports and Data Requested Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No [J No Visible/Fine Layer 9'4 to 1' 0> 1" South East West [] N/A j] N/A 0 N/A Yes ❑ No D Ye ❑ No ❑ Ye ❑ No ❑ No Visible/Fine Layer h to 1" No Visible/Fine Layer D % to 1" HNoVsible/Finel-ayer D % to 1" D] > 1" >1' D>1 Facade Description: I fl fl

Roof Debris: n No Visible line Layer 4 to 1" ' ' > 1' Description Irt;' c v' v •C

Setbacks N/A Floor. Debris: fl No Visible/Fine Layer fl % to 1' ❑ > 1" Floor. ___ Debris: No Visible/Fine Layer 'A to 1 > 1' Floor: Debris: No Visible/Fine Layer 34 to 1' 0> 1' Floor. Debris: 0 No Visible/Fine Layer 36101. > 1" Floor____ Debris: 0 No Visible/Fine Layer V to 1' > 1' Comments

Date: Inspection Team: Name: .#L— Agency: Name: Agency:

NYC-WTC 000122162