WTC building inspection form, 125 Church Street, undated

NYC 9/11 Public Portal Document 1 WTC Visual Survey Form Premise Address:

Blo 13 Resides I merciaPrJ fName of Building: ~pf Lot: i i 1Nc, Mix UseD Other # of Stories: AKA's: (\S 4 Building Ow er(Man ge~nent: Telephone Number: S/ () -7 g 3 - 6 e o Name: 1i5 C`Jt~ 1~ ~,~ T. Address: On Site Co ct: Name: 0rU^^ Telephone Number: Building Owner Management Activities interior Survey Performed es ❑ No Exterior Survey Performe es ❑ No General Clean Up ❑Yes o Locations: ACM Clean Up ❑ Ye No Locations: Air Monitoring 0 Yes No Locations: Copies of All Reports and Data Requested Yes

Visual Inspection Results: Facade: .1inspected De ris North 0 N/A EYes ❑ No No Visible/Fine Layer 0½ to 1" 0>1 ", South ❑ N/A BYes ❑ No 0 No Visible/Fine Layer ❑ % to 1" ❑ > 1" East ❑N/A ❑Yes❑No No Visible/Fine Layer ❑'/ to 1" ❑ > 1" West ❑ N/A 4z-yes ❑ No f o Visible/Fine Layer ❑ % to 1" ❑ > 1" Facade Description: LeJ

Roof Debris: No Visible /Fine 'Layer ❑Mato 1" `' } 0>1 0 Description: ~J \ ;

Setbacks N/A ❑ Floor: Debris: 0 No Visible/Fine Layer ❑% to 1 ❑ > 1" Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer 0 Y: to 1" ❑ > 1" Floor: Debris: ❑ No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Floor: Debris: 0 No Visible/Fine Layer ❑ Va to 1" ❑ > 1" Comments

*1Vl 44t. 9) u, (i1 G LEI ~c'. f T~ Date: S /' ' Inspection Team: Name: Agency: Name: Agency:

NYC-WTC 000126539