WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document • fi : WTC Visual Survav Form 1i t ehur~hd Premise 21 owk. P~ Block: Residential D Commercial Name of Building: Lot: Mix Use 0 Other # of Stories: S AKA's: Building Owner/Management: Telephone Number: ( ) Name: FAX: Address:

Name: P11 Telephone Number:; P11 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 Q Yes

visual inspection Results: Facade: Inspected Debris North ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer [9'x/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" West ❑ N/A [ Yes ❑ No ❑ No Visible/Fine Layer f /2 to 1" ❑ > 1" Facade Description:

Roof

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

Setbacks N/An Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ • 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ %2 to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Comments C S - C 1 __ i

Date: I //2002 Inspection Team: Name: Agency: ^;~- f' Name: Agency: A f iy NYC-WTC 000126530