WTC facade inspection form, 200 Church Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form /DO fC f4 Premise Address:

Block: ResidentialD Commercial 0 Name of Building: Lot: MixUseD Other # of for es: 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 0 Yes [] No General Clean Up ❑ Yes ❑ No Locations: ACM Clean Up ❑ Yes 0 No Locations: Air Monitoring ❑ Yes 0 No Locations: Copies of All Reports and Data Requested Yes

visual inspection esuits: Facade: Inspected Debris North ❑ N/A EYes ❑ No No Vsible LLror ❑ i4 to 1'. ❑ > 1" South 0 N/A J Yes 0 No No Visible ❑ Va to 1" 0>1' > 1" East West RN/A N/A

Facade Description: 9Yes0No ❑ Yes ❑ No ❑ No VBible/Fine Layer ❑ No Vsible/Fine Layer ❑ 4 to 1" ❑ 32 to 1" 0>1' 0>1'

Roof

Debris: []No Visible /Fine Layer E'h to 1" ❑ > 1" Description: S4-

Setbacks N/A[ Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1' 0> 1' Floor, ___ Debris: 0 No Visible/Fine Layer 0 V to 1" 0> 1" Floor Debris: 0 No Visible/Fine Layer 0 a to 1' 0> 1' Floor. Debris: ❑ No Visible/Fine Layer 0 % to 1' 0> 1' Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1'

Date: I I /2002 Inspection Team: Name: 1 -m k S f/ll' Agency: 'r . Name: Agency: ENTERED NYC-WTC 000126484