FORM LETTERS

NYC 9/11 Public Portal Document AUG-06-2002 12S19 FROM DEP LEGAL IU r»tioz kyo

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I understand that I, or my aufeorized representative, may be present and observe fee Scope A cleaning and monitoring activities being perfonned in fee Residence if I choose "modified aggressive" air sampling of fee Residence. I understand feat if I choose "aggressive" air sampling of fee 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 fee occupants of fee Residence will be allowed to return to fee Residence until 48 hours after fee beginning of “aggressive* air sampling. I, or my authorized representative, agree to comply wife health and safety instructions that may be provided by EPA and/or NYCDEP’s contractors 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 fee Federal Emergency Management Agency. Instructions for such reimbursement will be provided upon request to EPA.

&AMPLING APPROACH

I understand that if I choose “aggressive" air sampling of fee 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 fee areas being sampled.

I understand feat if I choose "modified aggressive" air sampling of the Residence, one or more oscillating fans will be used to circulate air throughout fee areas being sampled.

I understand feat 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 fee conclusion of fee investigation, EPA will provide fee undersigned wife fee results of fee monitoring of the Residence. Monitoring data in EFA's data base for the Program will be made available to fee public, but fee identity of the participants will be kept confidential.

AUTHORIZED SIGNATURE

I certify that 1 am authorized to make this request on behalf of all the occupants of the Residence.

Signature Date

Name and Title (PRINT)

TOTAL P,06

NYC-VVTC_000150195