WTC building inspection form, 176 Church Street, undated

NYC 9/11 Public Portal Document

J WTC Visual Survey Form Premise Address:

Block: Residential 0 Commercial Name of Building: Lot: Mix Uses Other # of Stories: AKA's: Building Owner/Management: Telephone Number: Name: FAX: Address: On Site Contact: bao-4 ec . 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 0 Yes 0 No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

visual inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" South ❑ N/A J Yes[] No [D No Visible lr 0'4 to 1" 0>1" East ❑ N/A Yes 0 No No - Visible/ ❑ h to 1" 0>1" West ❑ N/A ❑ Yes ❑ No g No Visible/Fine Layer ❑ % to l" 0>1" Facade Description:

Roof

Debris: ]0 No Visible 934t01" 9>1" Description:

Setbacks N/A I Floor. Debris: 0 No Visible/Fine Layer 034 to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer 0 Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor. Debris: 0 No Visible/Fine Layer ❑ % to 1" > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ i4 to 1" 9> 1" Comments

Date: /g/2002 Inspection Team: Name: R(a-/rl Agency: 1 P Name: Agency: ENTE

NYC-WTC 000126494