WTC building inspection form, 75 Chambers Street

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise Address:

Block: Residential J Commercial Name of Building: Lot: Mix Use D Other # of Stories: ft AKA's: Building Owner/Management: Telephone Number: (z, z ) Name: /'I / ill, FAX: ( ) Address: ? -; -i ?- 6 -4 On Site Contact: Name: f /, N N - S.-Pet Telephone Number: ('Lt ) ; * S"6`sa Building Owner Management Activities Interior Survey Performed ❑ Yes Q 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 El Yes

Visual Inspection Kesuits: Facade: Inspected Debris North ©N/A ❑ Yes [] No ❑ No Visible/Fine Layer ❑ hA to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" East © N/A [ I Yes ❑ No ® No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West N/A Yes ❑ No No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Facade Description:

Roof

Debris: Q No Visible /Fine ayer ❑'/2 to 1" -~'" ❑ > 1" f Description:

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

Comments

n~~s• 1 i ,`1 J N enenry / j1 r fit

Name: >< Agency: lyC)a=f~

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NYC-WTC 000122271