NYC 9/11 Public Portal Document
-3-
clothing.
I understand that 1, or my authorized representatixe, may be present and observe the Scope A cleaning
and monitoring activities being performed in the Residence if I choose “modified aggressive” air
sampling of the Residence. I understand that if I choose “aggressive” air sampling of the Residence, I
may only be present for the cleaning but not for the “aggressive” air sampling. Following
“aggressive” air sampling of the Residence, I understand that neither I nor the occupants of the
Residence will be allowed to return to the Residence until 48 hours after the begnning of
“aggressive” air sampling. I, or my authorized representative, agree to comply with health and safety
instructions for activities in the Residence under the Progum.
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 the NYCDEP. 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 and one or more oscillating
fans will be used to circulate air throu^out the areas being sampled.
I understand that if I choose “modified aggressive” air sampling of the Residence, one or more
oscillating fans will be used to circulate air throu^out the areas being sampled.
I understand that the air will pass throu^ a filter and be sampled. I also understand that wipe
samples of surfaces may be collected and analyzed.
I understand that at the conclusion of the in\cstigation, EPA will provide the undersigned with the
results of the monitoring of the Residence. Monitoring data in EPA’s data base for the Prog’am will
be made available to the public, but the identityof the participants will be kept confidential.
AUTHORIZED SIGNATURE
I certify that I am authorized to make this request on behalf of all the occupants of the Residence.
Signature Date
Name and Title (PRINT)
NYC-WTC_000163323
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