WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form Premise Address: It 2i o,-- PL Block: Residential 0 Commercial Name of Building: Lot: Mix Use J Other # of Stories: S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: -tL4 co -r 1 Telephone Number: 7t.) f'? - ]7O Building Owne anagement Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed 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 Results: Facade: Inspected Debris North ❑ N/A 'Yes ❑ No ❑ No Visible/Fine Layer [/z to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A [ ,Yes ❑ No ❑ No Visible/Fine Layer [3''/z to 1" ❑ > I" Facade Description: ~.... Li 't ' Ott

Roof

Debris: No Visible /Fine ayer ❑'h to 1" 1 ❑ > 1" / Description:

Setbacks N/A,~ Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %z to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: Q No Visible/Fine Layer ❑'/z to 1" ❑ > 1"

Comments

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Name: Agency: A~R/v NYC-WTC 000126506