NYC 9/11 Public Portal Document
SEP-05-2002 15:02 FROM DEP LEGAL TO 4422 P.04Z06
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I understand feat I, or my authorized representative, may be present and observe the Scope A cleaning
and monitoring activities being performed in fee Residence if I choose “modified aggressive” air
sampling of fee Residence. I understand feat if I choose “aggressive” air sampling of the Residence, I
may only be present for fee cleaning, but not for fee “aggressive” air sampling. Following
“aggressive” air sampling of fee Residence, I understand feat neither I nor the occupants of fee
Residence will be allowed to return to fee Residence until 4g hours after the beginning of “aggressive”
air sampling. I, or my authorized representative, agree to comply wife health and safety instructions
for activities in the Residence under the Program.
I agree that insurance payments and/or My other compensation which I received, or will receive in the
future, for activities covered by the Program at fee Residence, and which J have not spent for such
purposes, will be paid to the NYCDEP. Instructions for such reimbursement will be provided upon
request to EPA.
SAMPLXNG APPROACH
1 understand feat if I choose “aggressive” air sampling of the Residence, an electric-powered leaf
blower will be used to direct air onto all surfaces and personal property, and one or more oscillating
fans will be used to circulate air throughout the areas being sampled.
1 understand feat if I choose “modified aggressive" air sampling of the Residence, one or more
oscillating fans will be used to circulate air throughout the areas being sampled.
I understand feat fee air will pass through a filter and be sampled. I also under.Ttand that wipe samples
of surfaces may be collected and analyzed.
I understand feat at the conclusion of the investigation, EPA will provide the undersigned with the
results of the monitoring of fee Residence. Monitoring data in EPA’s data base for the Program will
be made available to fee public, but the identity of fee participants will be kept conftdential.
AUTHORIZED SIGNATURE
1 cenify thar I am authorized to make this request on behalf of ail the occupants of fee Residence.
Signature Date
Name and Title (PRINT)
NYC-WTC_000148064
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