WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document

WTC Visual Survey Form /11 ehu,Ch ,..S# Premise Address: t21 'owtc- Pt. Block: Residential 0 Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: ,r e, -t-4 Telephone Number: 7 / 7 - 67 70 Building 0wner.Wanagement 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 3'Yes ❑ No 0 No Visible/Fine Layer [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 ❑ Y2 to 1" ❑ > 1" West ❑ N/A [ Yes ❑ No ❑ No Visible/Fine Layer []'/ to 1" ❑> V Facade Description: rs.ct4t4. 4t

Roof

Debris: No Visible /Fine tayer ❑'/2 to 1" •1 ❑ > 1" 1 Description:

Setbacks N/A,% Floor. Debris: ❑ No Visible/Fine Layer 0 Va to 1" ❑ =• 1" Floor: Debris: ❑ No Visible/Fine Layer ❑'/ to 1" 0>10 Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1"

Comments

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Date: I / Z1 /2002 Inspection Team: Name: Agency: Name: ' _T - Agency: A~Riy NYC-WTC 000126507