Building representative request for WTC dust cleaning program

NYC 9/11 Public Portal Document

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I understand that the Program activities will require access, among other things, to the common areas and heating, ventilation and air condition systems (“HVAC”), the interior spaces, storage areas, elevators, and furnishings such as carpeting and upholstered furniture in the common areas of the Building. Cleaning activities will be performed, as necessary, throughout the entire Building and for the HVAC system.

I understand that the Program will employ various methods of dust removal from all surfaces, including, but not limited to, vacuuming, steam cleaning and wet wiping.

I understand that I, or my authorized representative, may be present and observe the Scope A cleaning and monitoring activities being performed in the Building.

I agree that insurance payments and/or any other compensation which was received for the Building, or will be received in the future, for activities covered by the Program for the Building, and which has not been 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 RESULTS

I understand that at the conclusion of the investigation, EPA will provide the undersigned with the results of the monitoring of the Building. Monitoring data in EPA’s data base for the Program will be made available to the public, but the identify of the participants will be kept confidential.

AUTHORIZED SIGNATURE

I certify that I am authorized to make this request for the Building.

Signature Date

Name and Title (PRINT)

NYC-WTC_000154092