WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document

• TT .ter ' WTC Visual Survey Form // I ehur~,4 ,.S' Premise Address: 'i21 Vowtc. PI Block: Residential 0 Commercial Name of Building: Lot: Mix Use D Other # of Stories: S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site - Name: P11 Telephone Number PII Bulldln~ Interior Survey Performed Yes ❑ No Exterior Survey Performed Yes ❑ No General Clean Up ® Yes No Locations: ACM Clean Up Q Yes Q No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested . Yes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A Q'Yes ❑ No ❑ No Visible/Fine Layer 04 /2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" East ❑ N/A ❑Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A [ •Yes ❑ No ❑ No Visible/Fine Layer I ''/2 to 1" ❑ > 1" Facade Description: cL- -h

Roof pt Debris: No Visible /Fine ayer ❑ Y2 to 1" •1 =u1 ❑ > 1" ) Description:

Setbacks N/A,% 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 ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1"

Comments

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Date: I / /2002 Inspection Team: Name: Agency: f~ Name: T- Agency: ' -fl A4R1y NYC-WTC 000126507