Asbestos inspection report form, 22 Chatham Square, Oct 2001

NYC 9/11 Public Portal Document

v WTC Visual Survev Form (0 O33?S Premise Address: I C- r m Q i3lock: Residential Commercial Name of Building: Lot: Mix Use Other S of Stories: AKA's: Building Owner nag ant elephone Number Name: FAX: Address: c fl C v-z roc' A'-( Y., — 300G 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 ❑NIA ❑Yes❑No O No Visible/Fine Layer 034t01' 0>1' South ❑ N/A ❑ Yes [] No No Visible/Fine Layer % to l' 0>1' East ❑ N/A ❑ Yes (] No No Visible/Fine Layer % to l' 0>1' West ❑ N/A DYesJJNo No4Visible/Fine Layer 034101' 0>1' Facade Description:

Roof

Debris: No visible /Fine Layer .❑ 34 to? ❑ > 1" Description:

Setbacks N/A Floor____ Debris: Q No Visible/Fine Layer ❑ 16 to 1' ❑ >1' Floor____ Debris: No Visible/Fine Layer 016 to? a > 1' Floor____ Debris: No Visible/Fine Layer ❑ i4 to 1" ❑ > 1' Floor____ Debris: Q No Visible/Fine Layer ❑ 34 to 1" > 1' Floor: Debris: [] No Visible/Fine Layer ❑ % to 1" B20 1'

Comments

Date: I 12002 Inspection Team(Nama:L Agency: Name: Agency: N T E R E$

NYC-WTC 000126958