Building inspection form, 122 Chambers Street, 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: '52 W RRRC~1 S-r. Block: Residential D Commercial 0 Name of Building: Lot: Mix Use Other # of Stories: AKA's: 17. t_ A • 1 Px St . Building OwneFManagement: 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 Results: Facade: In pected ris North ❑ N/A ❑ No iibl o ❑Y2t0 1" 0>1" South [J,V/A es❑No D isib a/Fine La ❑Y2to1" 0>1" East A ❑ ❑ No ❑ No Vise ayer ❑Y2to1" 0>1" West . N/A ❑Yes❑No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description: L

Roof

Debris: Description:

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

Comments

Date: /./2002 Inspection Team: Name: W U c2 r oN H N0' +c.44 Agency: GL Name: çIi ,- '€IiL4c Agency:

NYC-WTC 000127402