Label sheet for 139 Chambers Street WTC file

NYC 9/11 Public Portal Document

WTC Visual Survey Form /S ? 4h"I ~' Premise Address: 7 1Li u gig~-e Gtr .

Block: Residential 0 Commercial Name of Building: Lot: Mix Use Other # of Stones: to 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 Kesutts: Facade: Inspected Debris Q Yes ❑ No ❑ No Visible/Fine Layer ®Y to 1" 0>1" North G N/A 0>1" South ® N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/ to 1" ❑ > 1" Facade Description: A4 P" /

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1" 0>1" Description:

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 ❑ % to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments

Date: / /2002 Inspection Team: Name: Agency: Name: M' i:r.t LK Agency:

NYC-WTC 000127225