Interagency coordination memo, June 2002

NYC 9/11 Public Portal Document

2

Background sampling and analysis will consist of the following:

Three air samples collected from pumps running for an eight-hour time period in the Residence (twenty-inch oscillating fans will be used to suspend dust for the duration of the sampling);

Vacuum samples collected from carpets, drapes, and fabric furniture in living areas;

Wipe samples collected from horizontal surfaces of tables, counters, bare floors, walls and ceilings;

Samples collected from individual air conditioning/heater units.

Each sample will be analyzed for asbestos and lead. Wipe samples will also be analyzed for dioxins, polyaromatic hydrocarbons (PAH’s), silica, calcite, gypsum, man-made fibers (such as ceramic dusts), and total dust. Upon completion of the analyses, EPA will distribute the individual sampling results to each volunteer.

I understand that I, or my authorized representative, must be present during the sampling and may observe the activities being performed in the Residence, and I, or my authorized representative, agree to comply with instructions provided by EPA.

This written permission is given voluntarily with knowledge of the right to refuse and without threats or promises of any kind.

I certify that I am the owner or tenant of the Residence, and I am authorized to grant access for the Background Study on behalf of all the residents of the Residence.

New York, New York Dated: Signature

Name (PRINT)

Telephone Numbers: Home­ work- Cellular Phone -

NYC-WTC_000162482