WTC building inspection form, 79 Chambers Street

NYC 9/11 Public Portal Document

• ''"lq CHA (^~►~ WTC Visual Survey Form 100 (a ZS Premise Address: / ~~ S , 7' Block: ! g Residential 0 Commercfal j Name of Building: Lot: Mix UseLi . Other " -" 1-f 4, D A # of Stories: f AKA's: Building Owner/Management: 22? 3 ,, I Telephone Number ( ) 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 Yes

visual inspection Kesuits: Facade: Inspected Debris North ❑ N/A [ 'es ❑ No J No Visible/ ❑ /2 to 1" 0>1" South ❑ N/A EYes ®'No Visible b ❑ % to 1" 0>1" East EN/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ®'N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y to 1" 0>1" Facade Description:

Roof

Debris: [ No Visible ❑ % to 1" ❑ > 1" Description:

Setbacks N/A Floor. Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: [] No Visible/Fine Layer ❑ V to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑V to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer 0V to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: /1/2002 Inspection by: Name: -ri w l24- Agency: E Name: Agency: ENTE RED

NYC-WTC 000122287