WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document •

WTC Visual Survev Form Premise Addres *21 ~0,4- Block: I Residential J Commercial J Name of Building: Lot: I Mix Use D Other # of Stories. S AKA's: /// mc. Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site.-Gmx~tairt,.--------------------------------------------------------------------------• ---------------------------------------------------- - Name: ! P11 Telephone Number:. P11 Buildirg-rrwner managemenrAcovmes .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.... Interior Survey Performed 3 Yes ❑ No Exterior Survey Performed Yes Q No General Clean Up ® Yes D No Locations: ACM Clean Up ❑ 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 [Yes ❑ No ❑ No Visible/Fine Layer [j/2 to 1" ❑ > 1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑ N/A Q Yes ❑ No ❑ No Visible/Fine Layer ❑ Y2 to 1" ❑ > 1" West ❑ N/A [,Yes ❑ No ❑ No Visible/Fine Layer Q''/ to 1" ❑ > 1" Facade Description:

Roof N. Debris: No Visible /Fine Layer ❑I - 1>1" .# Description:

Setbacks N/A Floor: Debris: ❑ No " Floor: Debris: ❑ No Floor: Debris: ❑ N 1w Floor: Debris: ❑ , w

Floor: Debris: J> 1l w

CommentsC tL

Date: I /?/2002 Inspection Team: Name: Agency: h F~ Name: " .T Agency:

NYC-WTC 000126531