NYC 9/11 Public Portal Document
JUN-21-2002 15:3s FROM DEP LEGAL
TO 3744 P.05Z05
-3-
my authorized representative, agree to comply with health and safety instructions that may be
provided by EPA and/or NYCDEP’s contractors for activities in the Residence under the Indoor
Air Residential Assistance 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 Indoor Air Residential Assistance Program at the
Residence, and which I have not spent for such purposes, will be paid to the Federal Emergency
Management Agency, 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
blower will be used to direct air onto all surfaces and personal property, along with fans to
circulate air throughout the areas being sampled.
I understand that if I choose “modified aggressive’’ air sampling of the Residence, fans will be
used to circulate dr throughout the areas that will subsequently be sampled.
I understand that the air will then be directed through a filter and 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. Individual information in EPA’s data base for the
Indoor Air Residential Assistance Program will not be made public.
authorized signature
1 certify that I am the owner or tenant of the Residence, and 1 am authorized to make this request
on behalf of all the occupants of the Residence.
Dated;
Signature
Name (PRINT)
TOTAL P.04
TOTAL P.05
NYC-WTC_000148077
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