WTC building inspection form, 125 Church Street, undated

NYC 9/11 Public Portal Document

WTC 'f Visual

Survey Form /r p I ' ` 1 Premise Address:

Block: I '3 Residential Commercial 0 I Name of Building: Lot: i # of Stories: Mix Use J Other0 AKA's: Building Owner/Management: It q r- -- 1: a phone Number ( ) Name: FAX: Address: On Site Contact: _ Name: Telephone Number. ' Building Owner Management Activities Interior Survey Performed []Yes ❑ No Exterior Survey Performed ❑ Yes ❑ 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 J Yes visual Inspection Results: Facade: Inspected Debris North ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑'%to1" 0>1" South ❑ N/A ❑ Yes ❑.No ❑ No Visible/Fine Layer ❑%2to1" 0>1" East ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%2to1" 0>1" West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to1" 0>1" Facade Description:

Roof

Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑ > 1" Description:

Setbacks N/A ❑ 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" Floor: Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1" Comments

Date: -/x/2002 Inspection by: Name: 'c ha(\ Agency: Name: Agency:

NYC-WTC 000126540