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← Document results/DEP Box 51/158 CHAMBERS STREET 1001492, 137/27
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WTC building inspection form, 158 Chambers Street

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Form recording facade inspection results and hazardous material status for a building at 158 Chambers Street.

NYC-WTC_000126978–000126979

Folder label: “158 CHAMBERS STREET 1001492, 137/27

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NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: ,c Block: Residential Commercial 9 Name of Building: Lot: Mix UseD Other * 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 Q No Exterior Survey Performed Yes No General Clean Up Yes No Locations: ACM Clean Up Yes ❑ No Locations: Air Monitoring Yes El No Locations: Copies of All Reports and Data Requested p Yes

Visual Inspection Results: Facade: Inspected Debris North N/A ❑Yes No No Visible/Fine Layer % to 1" D>v South 9 N/A Yes 9 No No Visible/Fine Layer % to 1 > 1" East 9 N/A Yes 9 No No Visible/Fine Layer Y2 to V > 1" West N/A n o No Visible/Fine Layer 34 to 1' D > 1" Facade Description: Yes - 0

Roof

Debris: Mlo Visible /Fine Layer D % to 1" ' L] > 1" Description:

Setbacks N/A 11 Floor __ Debns. ' No Yisi'blaM.me Leyer 3~ to 1" >I Floor__ Debris: No Visible/Fine Layer 4 to 1" > 1" Floor: Debris: No Visible/Fine Layer 34 to 1" > 1" Floor. Debris: No Visible/Fine Layer 4 to 1" > 1" Floor. Debris: 9 No Visible/Fine Layer % to 1" > 1" Comments

_ 11

Date:'/ < I002 Inspection Team: Name: v Agency: Name: Agency:

NYC-WTC 000126978

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NYC-WTC_000126978Source: NYC Law Department, mirrored locally

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