WTC building inspection form, 162 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: I 1 ?. L7 - N-wi; f L: rot Block: Name of Building: Lot: Mix Use ❑ Other # of Stories: AKA's: Building OwnerIM, Telephone Number: Name: FAX: ( Address: On Site Contact: • Name: Telephone Number:

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: Comes of All Reports and Data Requested ❑ Yes

Visual Inspection Kesu;ts: Facade: Inspected Debris ❑N/A ❑Yes❑No ❑ No Visible/Fine Layer El'/2 to 1" 0>1" North 0>1" South ❑ N/A © Yes ❑ No ❑ No Visible/Fine Layer ©'/2 to 1" ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" 0>1" East ❑ N/A 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2to1" Facade Description: _ -

Debris: ❑ No Visible /Fine Layer ❑'/2 to 1" ❑ > 1" Description: R' c'C L c i - h^can 36 UNrr

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 '/2 to 1" ❑ > 1" Floor: Debris: ❑ No VSible/Fine Layer ❑'/ to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"

Comments

Inspection Team: Name: f1 - Agency: Date: _I 2l- /2002 Agency: Name: H~ry~ ~-

NYC-WTC 000127018