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Document / 3 pages

WTC building inspection form, 100 Church Street, undated

Machine-extracted title · confidence 95%

Form recording visual inspection results of building facades and air monitoring status for a structure affected by WTC debris.

NYC-WTC_000126784–000126786

Folder label: “100 CHURCH ST 1001409, 125/20

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Scanned page image, NYC-WTC_000126785
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NYC 9/11 Public Portal Document

WTC Visual Survey Form 1.1201 t4 04 Premise Address: too C Ma f►6 N S, V.EET Block: i I Residential D Commercial Name of Building: Lot: 20 I Mix Usej Other # of Stories: ' AKA's: •1p L . Zs . Buildin Owner/Management W Telephone Number. ('19$) gpi tt Name: R R `wr.,T• As1 b•E'M(' P. FAX: (alt) 4r► • çy Address: top On Site Contact Name: ' %Gd CI t ai r4j.rj I , Telephone Number: Building Owner Management Activities Interior Survey Performed Yes Q No Exterior Survey Performed Yes Q No General Clean Up Yes No Locations:JA iia $ "tAri' ~t0 ACM Clean Up Yes No Locations: Air Monitoring Yes rJ No Locations: Copies of All Reports and Data Roquested Yes visual inspection Results: Facade: Inspected Debris North [] N!A ® Yes Q No No Visible1UD&l v r 'i4 to l' > 1'• South J N/A Yes No No Visible/Fine Layer ~4 to 1 O>v East 0 N/A Yes ❑ No No Visible/~ar D'/2t01 D>1 West NIA Yes ❑ No No Visible/Fine der 36 to 1' 0>1' Facade Description: blot POILt.o%! o NO 0.1 1~11Up1~♦ty 09 ems* oosra s10f:• ~ Debris: ❑ No Visible /Fine Layer N36 to 1' ' 9>? Description:

Setbacks N/ Floor. IM'" G R AVCI. Debris: 4NoMom • 41L AVe" Visible/Fine Layer 34 to 1' ❑ > 1' Floor.,J Debris: No Visible/Fine Layer % to 1- > 1' Floor Debris: No Visible/Fine Layer 'A to 1' >1' Floor, Debris: No Visible/Fine Layer 34101. > 1' Floor_,_, Debris: No Visible/Fine Layer 4 to 1' > 1'

Date: A*_!%1 ,11002 Inspection Team: Name: P M l T .IS RfW43Agency: b( Name: _ & i.T2-@A y at,S,1Agency:

NYC-WTC 000126785

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NYC-WTC_000126785Source: NYC Law Department, mirrored locally

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