Property information query form, 155 Chambers St, Jan 2002

NYC 9/11 Public Portal Document

WT( Viaiial Survav Form Premise Address: ) Block: Residential 0 Commercial D Name of Building: Lot: Mix Use 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 Yes

Visual Inspection KesulLs: Facade: Inspected Debris ❑ No Visible/Fine Layer Q Yz to l" 0>1" North ❑ N/A 0 Yes ❑ No 0>1" ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Yz to 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to l" 0>1" East ❑ N/A West ❑ N/A ❑ Yes ❑ No 0 No Visible/Fine Layer ❑Y to 1" ❑ > 1" Facade Description:

Roof

Debris: 0 No Visible /Fine Layer El1/a to 1" ❑ > 1" Description: 1 N~` c=c ( ?~ f-►' ~1 fH r?t',' / L

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 ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/Z to 1" ❑>1 Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1"

Comments

/x_/2002 Inspection Team: Name: ff L Agency: Date: 1 Agency: Name: /- t rGK

NYC-WTC 000127091