HVAC cleanup proposal for residential units, Feb 2003

NYC 9/11 Public Portal Document RUG-06-2002 12 17 FROM DEP LEGAL TO 4422 P.02/06

REQUEST FORM FOR. WORLD E CENTER INDOOR. DUST CLEANING PROGRAM

Name of Authorized Building Representative

Address

New York, New York

Telephone Number:

REQUEST fact sheets tG'teantn nei? ?' ti Ea t As authorized representative for the Building, I have read the Indoor Dust Cleaning Program Sheet on4rea4JLAQ on the World Trade Center U.S. Environmental Protection (Program") and considered the information provided to me by the Building would like to Agency ('EPA"). Having considered the cleaning and monitoring offered, the the Program. participate in the following cleaning and monitoring alternatives under

Initia1on fth llqwing: monitoring after the cleaning. I request dust cleaning of the Building identified above and

I request monitoring of the Building.

AGREEMENT and the New York City I consent to employees, authorized representatives and contractors of the EPA NYCDEP having access to Department of Environmental Protection (NYCDEP") and contractors for necessary to conduct dust cleaning the Building and the personal property in the Building, for as long as performed in accordance with the and monitoring activities. I understand that these activities are to be authority of the Robert T. Stafford roles of EPA and NYCDEP under the Federal Response Plan and the Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121 et during the scheduling meeting with I agree to inform EPA or its representatives or NYCDEP's contractor including, for example, time the Project Monitor of any building rules that are applicable to the Program, EPA and the restrictions, appropriate entrances to the building, and elevator usage. I agree to notify contractors retained by NYCDEP as early as possible, but no later than three business days, before the cancel the date for the cleaning and scheduled date for the work in the Building, if it is necessary to monitoring activities. retained by NYCDEP. I I understand that the cleaning and monitoring will be performed by contractors required to also understand that the contractors performing cleaning and monitoring activities are workers compensation and environmental maintain insurance coverage for commercial general liability, theft or impairment liability related to this work, and that they are also bonded to cover loss by times that they are destruction of property. The contractors are required to maintain such insurance at all conducting cleaner and monitoring activities in the Building.

NYC-WTC 000148069