WTC building inspection form, 79 Chambers Street

NYC 9/11 Public Portal Document "' ` 7q C MS ► Srr, :4 Premise Address: 63 //E WTC Visual Survav Form ~T l I r% I ( c 1 Block: l Residential 0 Commercial Name of Building: Lot: Mix Use D Other 0 — ` # of Stories: AKA's: Building Owner/Management 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 Results: Facade: Inspected Debris North ❑ N/A Yes ❑ No E'No Visible ❑'/ to 1" 0>1" South ❑ N/A Yes ❑ No ® No Visible ❑'2to 1" 0>1" East SN/A J Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1" West O N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" Facade Description:

Roof Debris: No Visible J r ❑'/ to 1" 0>1" Description:

Setbacks N/A g Floor Debris: ❑ No Visible/Fine Layer ❑ Y to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Comments

Date: Inspection by: Name: C rTJO h Agency: - Name: Agency:

NYC-WTC 000122292