WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document

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WTC Visual Survey Form Premise Address: z Mgt Block: Residential CommercialD Name of Building: Lot: Mix UseD Other # of Stories: AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: Telephone Number: Building Owner Management Activities Interior Survey Performed ❑ Yes Q No Exterior Survey Performed ❑ Yes 0 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 DYes

Visual Inspection Results: Facade: Inspected Debris North ❑ N/A D Yes ❑ No Q No Visible/Fine Layer ❑ % to 1" 0>1' South ❑ N/A Q Yes D No Q No Visible/Fine Layer 0 Va to 1" > 1" East ❑ N/A D Yes ❑ No Q No Visible/Fine Layer ❑'% to 1" B>1. West ❑ N/A Q Yes Q No Q No Visible/Fine Layer [] Va to 1" ❑ >V Facade Description: It_ « Ccw.~ JCi ens

N 0 No Visible /Fine layer 0% to 1' •1 - "'~ ❑ >

Sc acks N/A❑ Floor. Debris: j] No Visible/Fine Layer 0 % to V Floor: Debris: ❑ No Visible/Fine Layer ❑'% to 1" Floor: Debris: No Visible/Fine Layer % to 1' Floor: Debris: No Visible/Fine Layer '% to 1" Floor. Debris: No Visible/Fine Layer 0 V to V

Co iments

Oat : r /x_12002 Inspection Team: Name: Agency: Name: + CWAuc Agency:

NYC-WTC 000126529