WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: *2? owe- Q1 Block: 12 Residential 0 Commercial j Name of Building: Lot: 12 Mix Use D Other # of Stories. S AKA's: /// 5 ;;: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site. - Name: P11 Telephone Number;z P11 Interior Survey Performed Yes ❑ No Exterior Survey Performed jJ Yes ❑ No General Clean Up ® Yes D No Locations: ACM Clean Up ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

visual inspection Keswts: Facade: Inspected Debris North ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer [9'4/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/2 to 1" ❑ > 1" West ❑ N/A [,Yes ❑ No ❑ No Visible/Fine Layer Q''/2 to 1" ❑ > 1" Facade Description: iVTi.. 4t

Roof

Debris: No Visible /Fine ayer ❑'/2 to 1" •1 =~"' ❑ > 1" 1 Description:

Setbacks N/A,[ Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1"

Comments /~ c

Date: I //2002 Inspection Team: Name: -1i Agency: ` N' Name: Agency:

NYC-WTC 000126504