WTC building inspection form, 199 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form !remise Address:

Block: Resi ntial Commercial Name o Building: Lot: Mix Use D Other # of Stories: AKA's: Building Ow er/Mana a ant: Telephone Number: ( ) Name: FAX: ( j ) Address: On Site Tntact: Name: Telephone Number: P11 Building Owner Management Activities `------------------------------------------------------------- Interior Survey Performed ❑ Yes ❑ No Exterior Survey Performed ❑ Yes ❑ No General Clean Up 2 Yes ❑ No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested D Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑% to 1" ❑ > 1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Facade Description: F " C-i. /

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑> V Description: r.9 cis '

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"

Comments

/2002 Inspection Team: Name: Agency: Np-s Agency:

NYC-WTC 000126994