WTC building inspection form, 139 Chambers Street

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address:

Block: ResidentialD Commercial f J Name of Building: Lot: Mix Use • Other ❑ # of Stories: 1p 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 J Yes Visual Inspection Results: Facade: Inspected Debris North ❑ N/A ® Yes ❑ No ❑ No Visible/Fine Layer ®%2 to 1" 0>1" South ®N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ %2 to 1" 0>1" Facade Description: DV-LA s;

Roof

Debris: ❑ No Visible /Fine Layer ❑ Y2 to 1" ❑ > 1" Description:

Setbacks N/A ❑ Floor. Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor Debris: ❑ No Visible/Fine Layer 0 Y to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ h to 1" ❑ > 1"

Comments

Date: 1 /2002 Inspection Team: Name: Agency: Name: $-f i-si ILt t-K Agency:

NYC-WTC 000127226