Building inspection form, 122 Chambers Street, Feb 2002

NYC 9/11 Public Portal Document

WTC Visual Survey Form PrefhlseqA dress::- W SR Cyr s --r. Block: 3 Residential p CommercialD Name of Building: Lot: I0 Mix Use . Other ❑ # of Stories: LZ AKA's: 1 L A 1t . SI. Building Ownef 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 Results: Facade: In pected D ris North ❑ N/A ❑ No o ❑v2 to 1" ❑ 1" >

South /A es ❑ No isib a/Fine La ❑ %2 to I ❑>1" East A ❑ E1No ❑ No Visi ayer ❑ Y2 to 1" ❑ > I" West N/A. ❑ Yes ❑ No ❑ No Visible/Fine Layer fl to 1" ❑ > 1" Facade Description: QPfE \ c cam J'rL-1 Ct-CM

Roof

Debris: r '/2 to 1" ❑,> 1" Description:

Setbacks N/A Z Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ V2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1"

Comments

Date: I I2Of Inspection Team: Name: U , o t4 HE #v 0 i c vt v

Agency: CL Name: ? n - Cre itt4 ç Agency: I '

NYC-WTC 000127406