WTC building inspection form, 111 Church Street, undated

NYC 9/11 Public Portal Document rJ

WTC Visual Survey Form Premise Address: ~b2? OVv_ Qt Block: Residential 0 Commercial Name of Building: Lot: I 1 Mix Use 0 Other # of Stories. S AKA's: /// s ?ec Building Owner/Management: Telephone Number: ( ) Name: FAX: Address: On Site Contact: Name: l ,'i- Telephone Number: ( 7L) 7? - 77O Building Owne anagement Activities Interior Survey Performed Yes ❑ No Exterior Survey Performed jJ Yes ❑ No General Clean Up ® Yes D No Locations: ACM Clean Up 0 Yes ❑ No Locations: Air Monitoring ❑ Yes ❑ No Locations: Copies of All Reports and Data Requested Yes

visual Inspection KeSults: Facade: Inspected Debris North ❑ N/A [Yes ❑ No ❑ No Visible/Fine Layer [24/2to 1" 0>1" South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2to 1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑ % to 1" 0>1" West ❑ N/A (,Yes ❑ No ❑ No Visible/Fine Layer [~Y2to1" 0>1" Facade Description:

Roof

Debris: LA.No Visible /Fine Layer ❑• -1> 1" •# t.-4 . Description:

Setbacks N/A Floor: Debris: ❑ No \' Floor: Debris: 0 No Floor: Debris: 0 N . Floor: Debris: ❑ Floor: Debris: [

Comments S c ,~ . t L,

uate: Ii frzvvz Inspection Team: Name: Agency: r Name: " .T Agency:

NYC-WTC 000126531