Asbestos bulk sampling chain of custody for 95 Chambers Street,

NYC 9/11 Public Portal Document

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WIC Visual Survey Form Premise Address: / c 1 ►it1r~s Block: Residential 0 Commercial Na of Buildin Lot: Mix UseD Other 0 !7, I ii J e y' S f # of Stories: j - AKA's: Building Ow{%er/Management: Telephone Number. ( ) _ çc i Name: - • z -o FAX: Address: On Site Contact: Name: 1r- e i Telephone Number Zi'Z ? S P7 Building Owner Management Activities interior Survey Performed Q Yes [0 No Exterior Survey Performed Q Yes [D No General Clean Up E] Yes[]No Locations: 4 ii {/ac s .or 1~+++n~ ~rf, P ACM Clean Up ❑ Yes No Locations: t 4a.I . S/p i w Air Monitoring ❑ Yes Q No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North J N/A D Yes D No Q No Visible/Fine Layer ❑ Ya to 1" O>1" South ❑ N/A D Yes ❑ No >!, No Visible/Fine Layer [„J 034t01" O>1" East Q N/A Q Yes O No ❑ No Visible/Fine Layer D % to 1" ❑ > 1" West © N/A [J Yes Q No =J No Visible/Fine Layer ❑ % to 1" O> 1" Facade Description: c Wit. . .

Roof ,st Debris: p No Visible /Fine Ayer. ( ( 34 to VI ❑ 1 Description: v '

Setbacks N/A O Floor. Debris: O No Visible/Fine Layer ❑'4 to 1" O> 1" Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑'% to 1" ❑ > 1" Floor: Debris: Q No Visible/Fine Layer 03410 1" > 1" Floor: Debris: O No Visible/Fine Layer O to 1" - O > 1"

Comments

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NYC-WTC 000122167