WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document 'r Y~

WTC Visual Survey Form '0 Preibise Address:

Block: Residential D Commercial LI I Name of Building: Lot: Mix Use Ot # of Stores: AKA's: Building Owner/Management: '7ki%e2irQ ,ig — Telephone Number: ( ) Name: FAX: Address: On Site Contact: 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 ❑ Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested J Yes vJsudI In5peUuun mWouuw. Facade: Inspected Debris North ❑ N/A Q Yes ❑ No J No Visible/Fine Layer ❑ % to 1" ❑ > 1" South ❑ N/A [ Yes ❑ No Q No Visible/Fine Layer ❑ % to 1" O> 1" East ❑ N/A Q Yes ❑ No Q No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A D Yes ❑ No Q No Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description:

Roof

Debris: ❑ No Visible /Fine ayer ❑ Y to 1" •1 ;A'"'4 0>1 0 / •i " ✓' Description:

Setbacks N/A ❑ Floor: Debris: ❑ No Visible/Fine Layer 0 % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Y: to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Vi to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ V to 1" ❑ > 1"

Comments

Date: t' I / /2002 Inspection Team: Name: ~C. Agency: Name: _ 116nr&K Agency:

NYC-WTC 000126510