WTC building inspection form, 158 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form ( emise Address: ! s Block: Residential1 Commercial 0 Name of Building: Lot: Mix Use D 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 ❑ No Exterior Survey Performed 0 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 ❑ No Visible/Fine Layer ❑vato1" 0>1" South ❑ N/A ❑ Yes [] No ❑ No Visible/Fine Layer ❑%to1" 0>1" East ❑ N/A ❑ Yes ❑ No O No Visible/Fine Layer ❑%to 1" 0>1" West ❑ N/A ❑ Yes ❑ No O No Visible/Fine Layer ❑%to l" 0>1" Facade Description: Fi

Roof s N Debris: ❑ No Visible /Fine yer 0% to 1" •4 '" 0>1" ' Description:

Setbacks N/Ak Floor. Debris: ❑ No Visible/Fine Layer ❑ v to 1" ❑ > 1" Floor. Debris: ❑ No VSible/Fine Layer ❑ va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer 0½ to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: /2002 Inspection Team: Name: 7~~-- Agency: Name: Agency:

NYC-WTC 000126979