DEP request for environmental hazard assessments, 160 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: Residential D Commercial Name of Building: Lot: Mix Use 0 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 ❑ 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 E Yes

Visual Inspection Kesuizs: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A [ ] Yes ❑ No ❑ No Visible/Fine Layer 0Y2t0 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ va to 1" 0> 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" E1> 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer „ J to 1" ❑ > 1" 'CsC h2 1 r ' .j t ' _7 Description:

Setbacks N/A] Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Yz to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

Date: d' i //2002 Inspection Team: Name: - Agency: Name: i.(Ci\r '~-.t td1 Agency: fk ti■

NYC-WTC 000126984