NYC 9/11 Public Portal Document
SEP-05-2002 1502 FROM DEP LEGAL TO 4422 P.04/06
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I understand that I, or my authorized representative, may be present and observe the Scope A cleaning
and monitoring activities being performed in the Residence if I choose "modified aggressive" air
sampling of the Residence. I understand that if I choose "aggressive'' air sampling of the Residence, I
may only be present for the cleaning, but not for the "aggressive" air sampling. Following
"aggressive" air sampling of the Residence, I understand that neither I nor the occupants of the
Residence will be allowed to return to the Residence until 48 hours after the beginning of "aggressive"
air sampling, I, or my authorized representative, agree to comply with health and safety instructions
for activities in the Residence under the Program.
I agree that insurance payments and/or any other compensation which I received, or will receive in the
future, for activities covered by the Program at the Residence, and which I have not spent for such
purposes, will be paid to the NYCDEP. Instructions for such reimbursement will be provided upon
request to EPA.
SAMPLING APPROACH
I understand that if I choose "aggressive" air sampling of the Residence, an electric
-powered leaf
all
blower will be used to direct air onto surfaces and personal property, and one or more oscillating
fans will be used to circulate air throughout the areas being sampled.
l understand that 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 that the air will pass through a filter and be sampled. I also understand that wipe samples
of surfaces may be collected and analyzed-
I understand that at the conclusion of the investigation, EPA will provide the undersigned with the
results of the monitoring of the Residence. Monitoring data in EPA's data base for the Program will
be made available to the public, but the identity of the participants will be kept confidential.
AUTHORIZED SIGNATURE
I certify that I am authorized to make this request on behalf of ail the occupants of the Residence.
Signature Date
Name and Title (PRINT)
NYC-WTC 000148064
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