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Imagine the result Consolidated Edison Company of New York, Inc. Interim Site Management Plan – Annual Indoor Air Monitoring Report Former East 11th Street Works Manhattan, New York July 2013

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Interim Site Management Plan – Annual Indoor Air Monitoring Report Margaret Carrillo-Sheridan, P.E. Former East 11th Street Works Vice President Site, Manhattan, New York Prepared for: Consolidated Edison Company of New Bruce W. Ahrens York, Inc. Associate Vice President Prepared by: ARCADIS of New York, Inc. 295 Woodcliff Drive Third Floor Suite 301 Aaron Falzarano Task Manager Fairport New York 14450 Tel 585 385 0090 Fax 585 385 4198 Our Ref.: B0043013.0003 Date: July 2013 This document is intended only for the use of the individual or entity for which it was prepared and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any dissemination, distribution or copying of this document is strictly prohibited.

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Table of Contents 1. Introduction 1 2. Indoor Air Monitoring 2 3. Results and Conclusions 5 3.1 Jacob Riis Housing Development 5 4. Work Plan Deviations 7 Tables Table 1 Sample Collection Dates (included in text) Table 2 Indoor Air Monitoring Summary Table 3 Indoor Air Analytical Results – Jacob Riis Figures Figure 1 Site Plan with Air Monitoring Locations Attachments 1 NYSDOH Indoor Air Quality Questionnaires and Building Inventory Forms (on compact disk) 2 Photographic Logs – Building Inventories (on compact disk) 3 Sample Collection Logs (on compact disk) 4 Data Usability Summary Reports (DUSRs) (on compact disk) 5 Photographic Logs – Indoor Air Monitoring Locations (on compact disk) 1221311807 ismp report.doc i

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York 1. Introduction This report presents a summary of the results from the 2013 annual indoor air monitoring conducted by ARCADIS of New York, Inc. (ARCADIS) on behalf of Consolidated Edison Company of New York, Inc. (Con Edison). Indoor air monitoring was conducted in accordance with the procedures and protocols presented in the Interim Site Management Plan for Indoor Air Monitoring (ARCADIS 2009) (ISMP). The ISMP is a component of a comprehensive monitoring plan that is being developed to ensure that the public and the environment are protected until a final remedy for the site is implemented. Indoor air monitoring was conducted at one property within the Former East 11th Street Works site (the site). The property included in the 2013 monitoring event was the Jacob Riis Housing Development. Access was not obtained to conduct air monitoring at the Haven Plaza North Co-Op Apartments or Saint Emeric’s (Escuela Hispania Montessori Head Start School [formerly Saint Emeric’s Roman Catholic School] or the Church of Saint Emeric’s). A summary of the activities performed associated with the 2013 annual indoor air monitoring is included below. Tabulated laboratory results from the indoor air monitoring, a figure showing the sampling locations, photographic logs, sampling forms, and a compact disk (CD) containing copies of the Data Usability Summary Reports (DUSRs) are included as attachments. Deviations from the scope of work presented in the ISMP are also presented. 1221311807 ISMP Report.doc 1

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York 2. Indoor Air Monitoring Prior to initiating field work, the site Health and Safety Plan (HASP) was reviewed to ensure that task specific monitoring activities were consistent with Con Edison’s Corporate Health and Safety Procedure A32.00 (Rules We Live By). A copy of the HASP was maintained on site during all work activities; all site personnel were required to review the HASP and sign an acknowledgement form stating that they understood the contents of the HASP and agree to abide by its requirements. Tailgate meetings were conducted each morning to discuss the day’s activities, critical work procedures, and safety requirements. No accidents or near misses occurred during the indoor air sampling events. The dates that the annual indoor air sampling events were conducted are presented in Table 1. Table 1 Sample Collection Dates Location Sample Collection Date(s) Jacob Riis Housing Development 170 Avenue D, 178 Avenue D, 1115 FDR Drive March 26 through 28, 2013 1141 FDR Drive, 1223 FDR Drive Pre-monitoring walk through visual inspections and chemical inventories were conducted concurrent with indoor air monitoring activities at each of the sampling locations. The objectives of the walk-through inspections and chemical inventories were to visually identify conditions that may affect or interfere with the indoor air monitoring, document the physical condition of the indoor air monitoring areas, and to confirm the sampling locations. Conditions identified during the visual inspections were generally consistent with conditions identified during visual inspections conducted in 2010 and 2011. Evidence of flooding (e.g., water marks on the exterior foundation walls surrounding the sample collection areas) was evident as a result of Hurricane Sandy, which severely impacted the lower east side of Manhattan in October 2012 (approximately 5 months prior to this ISMP sampling event).During the walk-through inspections, floor construction details for each building were documented and New York State Department of Health (NYSDOH) Indoor Air Quality Questionnaires and Building Inventory Forms were completed (Attachment 1). Photographs of the areas where samples were collected to document general background conditions and the chemical products present that potentially contain volatile chemicals during the walk- through inspections are included on a compact disk (CD) provided in Attachment 2. 1221311807 ISMP Report.doc 2

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York The locations selected for indoor monitoring are presented on Figure 1. For consistency, the selected locations for each property were consistent with the locations sampled during the 2007, 2010, and 2011 indoor air monitoring events. As identified in the photographic logs, small quantities of containers containing paints, solvents, cleaning supplies, and/or maintenance-related chemical products were present in each of the buildings during the walk-through inspections. These conditions are also similar to the conditions identified during the walk-through inspections associated with the previous sampling events. Removal of these potential interferences prior to collection of indoor air samples was not feasible. A portable organic vapor monitor (ppbRAE) was used to measure volatile organic compounds (VOCs) liberated from these contemporary chemicals. The measured concentrations of VOCs in each area monitored in each building are summarized in Table 2. The highest background VOC concentrations obtained from indoor air at each of the buildings was recorded at the following location:  178 FDR Drive: 352 parts per billion [ppb] was detected in the ambient air of the “compactor room”. Photographic logs documenting the conditions/stored products at these locations are included on a CD as Attachment 5. Air samples for laboratory testing were collected using batch-certified clean, 6-liter SUMMA canisters equipped with laboratory pre-set flow regulators for 8-hour sample collection. Indoor air samples were collected from within the ground levels of each building within the breathing zone (approximately 4 feet above the floor). The date, times (start and end times), sample identification, and other required information were recorded on sample collection logs as described in the ISMP. The sample collection logs are included on a CD included as Attachment 3. Outdoor, ambient air monitoring was conducted from upwind locations each day indoor air samples were collected. Ambient air sampling locations are also presented on Figure 1. Air samples were sent to TestAmerica Laboratories (TestAmerica) located in Knoxville, Tennessee via overnight courier for analysis of the project compound list analytes by United States Environmental Protection Agency (USEPA) Method TO-15. The project compound list included standard TO-15 VOCs, along with n-alkanes, and branched alkanes and other “indicator” compounds reported as tentatively identified compounds (TICs). The laboratory provided ASP Category B-equivalent data packages for quality review. Laboratory data packages and associated quality control information were 1221311807 ISMP Report.doc 3

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York reviewed by qualified ARCADIS personnel to verify they met the project-specific criteria for data quality. Data Usability Summary Reports (DUSRs) were prepared that present the results from the data review for each sample data group; DUSRs are included on a CD included as Attachment 4. The DUSRs indicate that the laboratory results for each site met the data quality objectives and the data were considered usable. The laboratory results for the Jacob Riis Housing Development are summarized in Table 3. Consistent with ISMP requirements, for comparison purposes, the indoor air results are compared to the NYSDOH Upper Fence (F) Criterion for indoor air background data for fuel oil heated homes and the USEPA’s BASE guidance values for the 90th percentile background air levels to provide typical concentrations of VOCs in indoor air. 1221311807 ISMP Report.doc 4

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York 3. Results and Conclusions The results from the annual indoor air monitoring event are presented below. 3.1 Jacob Riis Housing Development Eighteen (18) indoor air samples (labeled based on building address), 3 ambient samples (AA-032613, AA-032713, and AA-032813), and 2 duplicate samples for quality control purposes (DUP-032613 and DUP-032813) were collected for laboratory analysis. The sample collection logs are included on a CD as Attachment 3; photographs documenting the sample locations and equipment set-up are included on a CD as Attachment 5. The laboratory results are presented in Table 3. The ISMP included the collection of five air samples from elevator shafts within the Jacob Riis buildings (one sample from an elevator shaft within each building sampled); however, based upon inspection with Con Edison prior to the 2010 monitoring event, the elevator shafts were unable to be accessed safely for visual inspection and sample collection without terminating elevator operation. Terminating elevator operation was not feasible; therefore, consistent with the pervious monitoring events, elevator shaft samples could not be collected. As indicated in Table 3, a total of 42 analytes included in the project-specific analyte list (including TO-15 VOCs, n-alkanes, branched alkanes, and other TICs) were detected in the 18 indoor air samples collected throughout the Jacob Riis Housing Development. A summary of the detected analytes include:  Of the 26 TO-15 VOC analytes detected in indoor air, 18 were also detected in ambient (i.e., outdoor) air (the 8 analytes detected in indoor air that were not detected in outdoor ambient air included 5 chlorinated compounds [multiple samples], styrene [5 samples], bromomethane [3 samples], and naphthalene [1 sample]).  When compared to the concentrations detected in the ambient air samples, 15 of the 18 TO-15 VOCs were detected in indoor samples at concentrations greater than the outdoor concentrations. The TO-15 VOCs detected at higher concentrations indoors included 10 chlorinated compounds, benzene, ethylbenzene, m- & p-xylene, o-xylene, and toluene. 1221311807 ISMP Report.doc 5

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York  Six of the TO-15 VOC analytes detected indoor were above the NYSDOH Upper F criterion (1,1,2,2-tetrachloroethane, chloroform, cis-1,2-dichloroehtene, tetrachloroethene, trichloroethene, and xylenes); three of those analytes were also present above the USEPA indoor air background level (chloroform [15 samples], cis-1,2-dichloroethene [1 sample], and tetrachloroethene [1 sample]).  Commonly identified “gasoline indicators” (e.g., n-butane, n-pentane, n-heptane, isooctane, isopentane and 2-methylpentane) that were included in the n-alkanes and branched alkanes analyte lists were identified in all outdoor ambient air samples and indoor air samples. Each of these analytes was detected in multiple indoor air samples at concentrations higher than detected in the ambient air samples.  Indene and thiopene were not detected in any of the samples collected; these compounds are commonly used as “Manufactured Gas Plant (MGP) indicators”. 3-Methylthiopene, an associated compound with thiopene, was detected in one indoor air sample collected from the trash compactor room in building 178 Avenue D; however, 3-methylthiopene is not an exclusive indicator of coal tar, it has also been detected in gasoline. Based on the types of analytes detected, as well as the solvents, cleaning supplies, petroleum, oils, and maintenance-related chemical products stored within the ground- level areas/basements, and coupled with the absence of MGP indicator compounds, the data suggests that MGP-related impacts do not exist in the areas monitored at Jacob Riis Housing Development. 1221311807 ISMP Report.doc 6

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Interim Site Management Plan – Annual Indoor Air Monitoring Report th Former East 11 Street Works, Manhattan, New York 4. Work Plan Deviations The following deviations from the scope of work presented in the ISMP occurred during the field activities:  Consistent with previous ISMP sampling events, due to the limitations of site access, the pre-monitoring walk through inspections and chemical inventories at each building were conducted concurrent with indoor air monitoring activities.  Consistent with the previous ISMP sampling events, the elevator shafts were unable to be accessed for walk-through inspections and monitoring due to the inability to safely access the shafts without terminating elevator operation. Terminating elevator operation was not feasible; therefore the samples could not be collected.  Haven Plaza North Co-Op Apartments and Saint Emeric’s (including the Escuela Hispania Montessori Head Start School and the Church of Saint Emeric’s) were not inspected and sampled due to lack of an access agreement. No additional deviations from the scope of work presented in the ISMP were noted. 1221311807 ISMP Report.doc 7

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Tables

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Sample ID JR-170-IA-1 JR-170-IA-2 JR-170-IA-3 JR-170-IA-4 JR-178-IA-1 JR-178-IA-2 JR-178-IA-3 AA-032613 JR-1115-IA-1 JR-1115-IA-2 JR-1115-IA-3 JR-1115-IA-4 JR-1141-IA-1 JR-1141-IA-2 JR-1141-IA-3 AA-032813 JR-1223-IA-1 JR-1223-IA-2 JR-1223-IA-3 JR-1223-IA-4 AA-032713 Note: 1. 5/2/2013 1221311807 Table 2.xls Table 2 Indoor Air Monitoring Summary ISMP Annual Indoor Air Monitoring Report Consolidated Edison Company of New York, Inc. Background PID Date Location Reading (ppb) 3/26/2013 170 Avenue D - Cabinet room 0 3/26/2013 170 Avenue D - Storage room 0 3/26/2013 170 Avenue D - Near tank room 0 3/26/2013 170 Avenue D - Compactor room 0 3/26/2013 178 Avenue D - Crawl space beneath building 0 3/26/2013 178 Avenue D - Meter room 0 3/27/2013 178 Avenue D - Compactor room 352 3/26/2013 Along fence between 178 Avenue D and Avenue D 0 3/28/2013 1115 FDR Drive - Cabinet Room 0 3/28/2013 1115 FDR Drive - Storage room outside of plaster room 0 3/28/2013 1115 FDR Drive - Tank room 0 3/28/2013 1115 FDR Drive - Plaster room 0 3/28/2013 1141 FDR Drive - Crawl space 0 3/28/2013 1141 FDR Drive - Tank room 0 3/28/2013 1141 FDR Drive - Crawl space 0 3/28/2013 Along fence between 1141 FDR Drive and FDR Drive 0 3/27/2013 1223 FDR Drive - Storage room (Southeast area of building) 0 3/27/2013 1223 FDR Drive - Storage room (Near center of building) 0 3/27/2013 1223 FDR Drive - Storage room (Near center corridor of building) 0 3/27/2013 1223 FDR Drive - Tank room 0 3/27/2013 Along fence between 1223 FDR Drive and FDR Drive 0 Background PID readings were obtained using a portable organic vapor monitor (ppbRAE) and are reported in parts per billion (ppb). Page 1 of 1

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Table 3 Indoor Air Analytical Results - Jacob Riis ISMP Annual Indoor Air Monitoring Consolidated Edison Company of New York, Inc. NYSDOH Fuel Oil USEPA BASE Location ID: Heat - Indoor Air Guidance Values AA-032613 AA-032713 AA-032813 JR-1115-IA-1 JR-1115-IA-2 JR-1115-IA-3 JR-1115-IA-4 JR-1141-IA-1 JR-1141-IA-2 JR-1141-IA-3 JR-1223-IA-1 JR-1223-IA-2 JR-1223-IA-3 JR-1223-IA-4 JR-170-IA-1 JR-170-IA-2 JR-170-IA-3 JR-170-IA-4 JR-178-IA-1 JR-178-IA-2 JR-178-IA-3 Upper Fence 90th Percentile (bold) (shade) Date Collected: Units 03/26/13 03/27/13 03/28/13 03/28/13 03/28/13 03/28/13 03/28/13 03/28/13 03/28/13 03/28/13 03/27/13 03/27/13 03/27/13 03/27/13 03/26/13 03/26/13 03/26/13 03/26/13 03/26/13 03/26/13 03/27/13 Volatile Organic Compounds 1,1,1-Trichloroethane 2.5 20.6 ug/m3 0.44 U 0.44 U 0.44 U 0.44 U [0.44 U] 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U [0.44 U] 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 1,1,2,2-Tetrachloroethane 0.38 -- ug/m3 0.55 U 0.55 U 0.55 U 0.55 U [0.55 U] 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U [0.55 U] 0.55 U 0.55 U 0.55 U 0.55 U 0.55 U 0.67 1,1,2-Trichloroethane 0.38 1.5 ug/m3 0.44 U 0.44 U 0.44 U 0.44 U [0.44 U] 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U [0.44 U] 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 0.44 U 1,1,2-Trichlorotrifluoroethane 2.5 -- ug/m3 0.49 J 0.48 J 0.50 J 0.48 J [0.49 J] 0.50 J 0.46 J 0.50 J 0.48 J 0.45 J 0.51 J 0.49 J 0.48 J 0.49 J 0.49 J 0.49 J [0.53 J] 0.49 J 0.48 J 0.49 J 0.50 J 0.52 J 0.47 J 1,1-Dichloroethane 0.38 0.7 ug/m3 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 1,1-Dichloroethene 0.4 1.4 ug/m3 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 1,2,4-Trichlorobenzene 0.47 6.8 ug/m3 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ [0.59 UJ] 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ [0.59 UJ] 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 UJ 0.59 U 1,2,4-Trimethylbenzene 9.8 9.5 ug/m3 0.39 U 0.18 J 0.16 J 0.17 J [0.21 J] 2.4 0.39 U 0.56 0.17 J 0.39 U 0.39 U 0.23 J 0.47 0.47 0.26 J 0.33 J [0.44] 0.24 J 0.38 J 0.35 J 0.71 0.37 J 0.39 U 1,2-Dibromoethane 0.38 1.5 ug/m3 0.61 U 0.61 U 0.61 U 0.61 U [0.61 U] 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U [0.61 U] 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 0.61 U 1,2-Dichloro-1,1,2,2-tetrafluoroethane 0.42 -- ug/m3 0.12 J 0.12 J 0.12 J 0.11 J [0.12 J] 0.11 J 0.11 J 0.13 J 0.56 U 0.12 J 0.093 J 0.12 J 0.11 J 0.11 J 0.11 J 0.12 J [0.12 J] 0.11 J 0.11 J 0.11 J 0.11 J 0.11 J 0.13 J 1,2-Dichlorobenzene 0.48 1.2 ug/m3 0.48 U 0.48 U 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 1,2-Dichloroethane 0.37 0.9 ug/m3 0.32 U 0.32 U 0.10 J 0.081 J [0.081 J] 0.32 U 0.11 J 0.32 U 0.14 J 0.12 J 0.11 J 0.32 U 0.088 J 0.32 U 0.32 U 0.088 J [0.091 J] 0.088 J 0.097 J 0.32 U 0.093 J 0.10 J 0.086 J 1,2-Dichloropropane 0.39 1.6 ug/m3 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 1,3,5-Trimethylbenzene 3.9 3.7 ug/m3 0.39 U 0.39 U 0.39 U 0.39 U [0.22 J] 0.97 0.39 U 0.19 J 0.39 U 0.39 U 0.39 U 0.39 U 0.13 J 0.17 J 0.39 U 0.39 U [0.16 J] 0.39 U 0.17 J 0.39 U 0.28 J 0.13 J 0.39 U 1,3-Dichlorobenzene 0.46 2.4 ug/m3 0.48 U 0.48 U 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 1,4-Dichlorobenzene 1.2 5.5 ug/m3 0.48 U 0.48 U 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.48 U 0.18 J 0.48 U 0.18 J 0.48 U 0.48 U [0.48 U] 0.48 U 0.48 U 0.17 J 0.24 J 0.17 J 0.48 U Benzene 13 9.4 ug/m3 0.67 0.75 0.64 0.59 [0.61] 0.59 0.57 0.60 0.61 0.46 0.69 0.60 0.75 0.77 0.68 1.3 [1.4] 0.72 1.3 0.98 1.7 1.1 0.62 Bromomethane 0.48 1.7 ug/m3 0.31 U 0.31 U 0.31 U 0.31 U [0.31 U] 0.31 U 0.31 U 0.31 U 0.31 U 0.31 U 0.068 J 0.31 U 0.31 U 0.31 U 0.058 J 0.31 U [0.31 U] 0.31 U 0.31 U 0.31 U 0.31 U 0.31 U 0.055 J Carbon Tetrachloride 1.3 1.3 ug/m3 0.51 0.48 0.51 0.52 [0.54] 0.50 0.52 0.51 0.57 0.49 0.56 0.51 0.50 0.46 0.51 0.50 [0.58] 0.43 0.52 0.53 0.56 0.53 0.51 Chlorobenzene 0.41 0.9 ug/m3 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U Chloroethane 0.39 1.1 ug/m3 0.21 U 0.21 U 0.067 J 0.21 U [0.21 U] 0.21 U 0.21 U 0.21 U 0.34 0.14 J 0.063 J 0.21 U 0.21 U 0.21 U 0.077 J 0.069 J [0.070 J] 0.21 U 0.067 J 0.086 J 0.089 J 0.085 J 0.12 J Chloroform 1.2 1.1 ug/m3 0.11 J 0.29 J 0.28 J 3.5 [3.7] 1.4 3.4 0.98 6.3 8.5 14 1.0 5.1 6.0 7.6 14 [14] 0.39 J 23 1.9 20 7.4 14 Chloromethane 4.2 3.7 ug/m3 1.0 1.0 1.0 1.1 [1.2] 1.0 1.3 0.92 3.5 1.6 1.5 1.0 1.0 1.0 1.0 1.2 [1.2] 1.2 1.2 1.3 1.5 1.2 1.4 cis-1,2-Dichloroethene 0.41 1.9 ug/m3 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 3.1 1.5 0.66 cis-1,3-Dichloropropene 0.38 2.3 ug/m3 0.36 U 0.36 U 0.36 U 0.36 U [0.36 U] 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U [0.36 U] 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U Dichlorodifluoromethane 10 16.5 ug/m3 2.5 2.5 2.5 2.5 [2.5] 2.5 2.5 2.5 0.86 1.0 1.1 2.5 2.4 2.4 2.5 2.6 [2.7] 2.6 2.5 2.5 2.5 2.6 2.7 Ethylbenzene 6.4 5.7 ug/m3 0.16 J 0.21 J 0.17 J 0.16 J [0.16 J] 5.5 0.19 J 0.70 0.15 J 0.12 J 0.35 U 0.19 J 0.30 J 0.29 J 0.24 J 0.33 J [0.42] 0.31 J 0.43 0.36 0.58 0.44 1.4 Hexachlorobutadiene 0.49 6.8 ug/m3 0.85 U 0.85 U 0.85 U 0.85 U [0.85 U] 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U [0.85 U] 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U 0.85 U Methylene Chloride 16 10 ug/m3 1.6 1.0 1.7 0.83 [1.1] 0.70 0.99 0.71 1.1 1.4 1.1 0.73 0.96 0.76 2.6 1.9 [1.1] 0.76 1.1 1.3 1.8 3.4 1.2 m-Xylene & p-Xylene 11 22.2 ug/m3 0.39 0.62 0.56 0.49 [0.52] 15 0.55 2.6 0.47 0.29 J 0.21 J 0.62 0.93 0.91 0.64 1.1 [1.4] 0.99 1.3 1.2 2.4 1.5 2.8 Naphthalene -- 5.1 ug/m3 1.0 U 1.0 U 1.0 U 3.2 [4.2] 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U [1.0 U] 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U 1.0 U o-Xylene 7.1 7.9 ug/m3 0.16 J 0.24 J 0.23 J 0.19 J [0.20 J] 4.1 0.21 J 0.83 0.18 J 0.35 U 0.35 U 0.24 J 0.37 0.36 0.23 J 0.42 [0.50] 0.33 J 0.48 0.39 0.88 0.58 0.59 Styrene 1.4 1.9 ug/m3 0.34 U 0.34 U 0.34 U 0.14 J [0.15 J] 0.34 U 0.34 U 0.34 U 0.34 U 0.34 U 0.34 U 0.34 U 0.34 U 0.10 J 0.34 U 0.34 U [0.34 U] 0.34 U 0.34 U 0.14 J 0.15 J 0.16 J 0.34 U Tetrachloroethene 2.5 15.9 ug/m3 0.58 0.81 0.51 J 3.8 J [0.51 J] 1.1 0.66 0.44 J 0.44 J 0.16 J 0.37 J 0.74 0.88 0.77 0.64 0.62 [0.84] 0.55 0.84 0.74 20 12 6.4 Toluene 57 43 ug/m3 1.1 1.1 1.0 1.1 [1.2] 1.2 1.0 1.4 0.86 0.39 0.63 0.94 1.3 1.3 0.99 2.1 [1.9] 1.4 3.4 1.7 3.6 2.8 3.0 trans-1,3-Dichloropropene 0.4 1.3 ug/m3 0.36 U 0.36 U 0.36 U 0.36 U [0.36 U] 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U [0.36 U] 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U 0.36 U Trichloroethene 0.46 4.2 ug/m3 0.21 U 0.21 U 0.15 J 1.6 [0.21 U] 0.084 J 0.21 U 0.21 U 0.082 J 0.21 U 0.16 J 0.21 U 0.21 U 0.21 U 0.21 U 0.081 J [0.087 J] 0.21 U 0.13 J 0.21 U 2.5 1.0 3.1 Trichlorofluoromethane 12 18.1 ug/m3 1.4 1.3 1.3 1.3 [1.3] 1.3 1.3 1.4 1.1 1.2 1.2 1.3 1.4 1.3 1.5 1.4 [1.5] 1.4 1.4 1.4 1.4 1.5 1.3 Vinyl Chloride 0.37 1.9 ug/m3 0.20 U 0.20 U 0.20 U 0.20 U [0.20 U] 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U 0.20 U [0.20 U] 0.20 U 0.20 U 0.20 U 0.31 0.19 J 0.099 J Total BTEX -- -- ug/m3 1.9 J 2.1 J 1.8 J 1.9 J [2.0 J] 7.3 1.8 J 2.7 1.6 J 0.97 J 1.3 1.7 J 2.4 J 2.4 J 1.9 J 3.7 J [3.7] 2.4 J 5.1 3.0 5.9 4.3 5.0 Total VOCs -- -- ug/m3 10 J 10 J 11 J 18 J [14 J] 24 J 13 J 12 J 17 J 16 J 22 J 11 J 16 J 17 J 19 J 27 J [28 J] 11 J 37 J 14 J 63 J 38 J 38 J n-Alkanes n-Butane -- -- ug/m3 1.7 2.1 2.0 6.4 [6.5] 44 D 5.1 120 D 20 14 14 1.7 3.4 3.6 4.4 6.1 [6.0] 2.0 5.2 3.7 5.1 3.5 6.0 n-Decane 15 17.5 ug/m3 2.3 U 0.28 J 0.29 J 0.71 J [1.5 J] 7.7 0.15 J 1.6 J 0.38 J 0.17 J 0.14 J 0.38 J 0.96 J 0.90 J 0.55 J 0.49 J [0.59 J] 0.62 J 0.49 J 1.5 J 7.1 1.4 J 2.3 U n-Dodecane 9.2 -- ug/m3 0.23 J 2.8 U 2.8 U 0.41 J [0.43 J] 1.1 J 2.8 U 2.0 J 2.8 U 2.8 U 2.8 U 0.31 J 0.40 J 0.43 J 2.8 U 0.69 J [2.8 U] 2.8 U 0.34 J 0.35 J 0.23 J 2.8 U 2.8 U n-Heptane 18 -- ug/m3 0.22 J 0.36 J 0.37 J 0.22 J [0.19 J] 0.49 J 0.26 J 0.61 J 0.24 J 0.17 J 0.20 J 0.18 J 0.31 J 0.28 J 0.28 J 0.48 J [0.50 J] 0.21 J 0.56 J 0.29 J 0.73 J 0.43 J 2.4 n-Hexane 14 10.2 ug/m3 0.45 J 0.56 J 0.62 J 0.32 J [0.37 J] 0.44 J 0.38 J 0.52 J 0.41 J 0.31 J 0.51 J 0.37 J 0.52 J 0.52 J 0.59 J 1.4 [0.96] 0.36 J 1.0 0.51 J 2.0 0.94 0.78 n-Octane 5.2 -- ug/m3 0.11 J 0.25 J 0.26 J 0.19 J [0.16 J] 0.65 J 0.16 J 0.68 J 0.17 J 0.75 U 0.071 J 0.14 J 0.27 J 0.22 J 0.19 J 0.29 J [0.33 J] 0.16 J 0.27 J 0.40 J 0.41 J 0.31 J 0.74 Nonane 7.9 7.8 ug/m3 1.0 U 0.23 J 0.22 J 0.21 J [0.24 J] 6.0 0.15 J 0.44 J 0.35 J 1.0 U 0.12 J 0.16 J 0.38 J 0.35 J 0.31 J 0.28 J [0.34 J] 0.25 J 0.26 J 0.64 J 0.34 J 0.22 J 1.0 U n-Undecane 12 22.6 ug/m3 0.16 J 2.6 U 2.6 U 0.38 J [0.50 J] 3.6 2.6 U 2.7 2.6 U 2.6 U 2.6 U 0.31 J 0.55 J 0.66 J 0.24 J 0.49 J [0.28 J] 0.26 J 0.35 J 0.70 J 0.47 J 0.22 J 2.6 U Pentane -- -- ug/m3 0.59 J 0.86 J 0.86 J 0.57 J [0.58 J] 2.1 0.66 J 3.2 0.68 J 1.0 J 0.94 J 0.60 J 1.2 1.2 1.5 1.4 [1.5] 0.77 J 1.6 2.1 4.7 1.9 1.8 Branched Alkanes (Reported as TICs) 2,3-Dimethylpentane 5.2 -- ug/m3 0.33 U 0.33 U 0.33 U 0.33 U [0.33 U] 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U 0.33 U [0.33 U] 0.33 U 0.33 U 0.33 U 0.38 0.33 U 0.40 Isopentane -- -- ug/m3 1.0 1.5 1.1 0.94 [0.93] 1.2 0.92 1.2 1.2 1.6 1.4 1.0 2.1 2.1 2.5 2.9 [2.9] 1.5 4.2 5.5 6.9 3.2 2.0 2-methylpentane -- -- ug/m3 0.31 0.45 0.38 0.28 U [0.29] 0.30 0.28 U 0.31 0.37 0.30 0.44 0.34 0.49 0.52 0.51 0.92 [0.94] 0.33 1.0 0.40 2.4 0.84 0.57 Other (Reported as TICs) 1,2,3-Trimethylbenzene -- -- ug/m3 0.39 U 0.39 U 0.39 U 0.39 U [0.39 U] 1.2 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U [0.39 U] 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 2-Ethylthiophene -- -- ug/m3 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U [0.37 U] 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 0.37 U 2-Methylthiophene -- -- ug/m3 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 3-Methylthiophene -- -- ug/m3 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U [0.32 U] 0.32 U 0.32 U 0.32 U 0.32 U 0.32 U 0.88 Indane -- -- ug/m3 0.39 U 0.39 U 0.39 U 0.39 U [0.39 U] 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U [0.39 U] 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U 0.39 U Indene -- -- ug/m3 0.76 U 0.76 U 0.76 U 0.76 U [0.76 U] 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U [0.76 U] 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U 0.76 U Isoctane -- -- ug/m3 0.17 J 0.24 J 0.20 J 0.15 J [0.15 J] 0.20 J 0.15 J 0.22 J 0.17 J 0.41 J 0.16 J 0.18 J 0.25 J 0.27 J 0.31 J 0.83 J [0.89 J] 0.20 J 0.94 0.29 J 1.0 0.43 J 9.5 Isopropylbenzene 0.82 -- ug/m3 0.79 U 0.79 U 0.79 U 0.79 U [0.79 U] 0.40 J 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U 0.79 U [0.79 U] 0.79 U 0.79 U 0.79 U 0.13 J 0.79 U 0.79 U Thiopene -- -- ug/m3 0.28 U 0.28 U 0.28 U 0.28 U [0.28 U] 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U [0.28 U] 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 0.28 U 4/26/2013 H:\Clients\ConEdison\PROJECTS\East 11th Street\OU-1\File 10 - Reports\2013 ISMP IA for Jacob Riis\Jacob Riis ISMP Data - Validated.xlsx Page 2 of 2

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Table 3 Indoor Air Analytical Results - Jacob Riis ISMP Annual Indoor Air Monitoring Consolidated Edison Company of New York, Inc. Lab Qualifier Definition D Sample required dilution prior to analysis. J Indicates an estimated value. U Indicates the constituent was not detected at the PQL. The value preceding the U indicates the PQL. [ ] Identifies duplicate sample collected for quality control purposes. bold font Indicates analyte exceeded its NYSDOH Upper Fence Criterion. shaded indicates analyte exceeded the USEPA's BASE Guidance Value (90th Percentile). 4/26/2013 H:\Clients\ConEdison\PROJECTS\East 11th Street\OU-1\File 10 - Reports\2013 ISMP IA for Jacob Riis\Jacob Riis ISMP Data - Validated.xlsx Page 2 of 2

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Figures

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CITY: SYRACUSE, NY DIV/GROUP: ENVCAD DB: A. SCHILLING R. ALLEN L. FORAKER LD: PIC: M. CARRILLO-SHERIDAN PM: B. AHRENS TM: B. AHRENS LYR: ON=*; OFF=*REF* G:\ENVCAD\SYRACUSE\ACT\B0043013\0003\00002\DWG\AIR\43013B01.dwg LAYOUT: 1 SAVED: 4/25/2013 11:40 AM ACADVER: 18.1S (LMS TECH) PAGESETUP: C-LD2B-PDF PLOTSTYLETABLE: PLTFULL.CTB PLOTTED: 4/25/2013 11:40 AM BY: FORAKER, LYDIA XREFS: IMAGES: PROJECTNAME: ---- 43013X01 43013X00 SITE PLAN WITH AIR FORMER EAST 11TH STREET WORKS MONITORING LOCATIONS 1 CONSOLIDATED EDISON COMPANY OF NEW YORK, INC. FIGURE ISMP ANNUAL INDOOR AIR MONITORING REPORT

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Attachment 1 NYSDOH Indoor Air Quality Questionnaires and Building Inventory Forms (on compact disk)

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106 Minuz D NEW YORK STATE DEPARTMENT OF HEALTH INDOORAIR QUALITY QUESTIONNAIRE AND BUILDING INVENTORY CENTER FOR ENVIRONMENTAL HEALTH This form must be completed for each residence involvedin indoorairtesting. Preparer’s Name Aaron Cariano Date/Time Prepared S/2S] 3 jo.Co Am ez ADdiS 145 Phone No.BRO- Preparer’s Affiliation Purpose of Investigation Tuned A, R_ Dam pri "lo 1. OCCUPANT: Interviewed: Y KN) Last Name: First Name: Address: County: Home Phone: Office Phone: Number of Occupants/personsat this location Age of Occupants 2. OWNER OR LANDLORD: (Check if same as occupant __) Sup Lem tor Interviewed{¥)/ N Last Name: Core e. First Name: Lato NY Address: 4 54 €AST | OTH Sr Geer County: Man Ary HomePhone: Office Phone: 212 - 22% - 2100 3. BUILDING CHARACTERISTICS Type of Building: (Circle appropriate response) Residential» School Commercial/Multi-use Industrial Church Other: 035911807 Appendix A.doc

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Page 2 If the property is residential, type? (Circle appropriate response) Ranch 2-Family 3-Family Raised RanchSplit Level Colonial MULTIon Cape Cod _ Contemporary Mobile Home . Duplex Apartment Townhouses/Condos Modular Log Home Other: If multiple units, how many? ¡1Y If the property is commercial, type? Business Type(s) No Rusia ss © Ali Kespanrrımı Doesit include residences(i.e., multi-use)? | / N If yes, how many? Other characteristics: Numberoffloors 13 Building age t lea NES Is the building insulated2(¥ / N Howair tight?Tight / Average / Not Tight 4. AIRFLOW Use air current tubes or tracer smoke to evaluate airflow patterns and qualitatively describe: Airflow between floors Nome — Ao Négrnert Wie Mevem oT ums "TIMO CH Gnp> IN Pipirte | Comphctoe , ot ZUWATOR SHAR. Airflow near source . Ai@ Years | Fars Paeseur WoT LARGE Caro (A TAMC Reom Otero Mn 4 xeformat Bik Flour i Comrat. (As. Outdoor air infiltration LAAG Faw in Tank Koom Client Pra Excunnee. Infiltration into air ducts Mec Pa Duers Peescar in Grow Liver. 035911807 Appendix A.doc

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Page 3 5. BASEMENT AND CONSTRUCTION CHARACTERISTICS (Circle all that apply) a. Above grade construction: wood frame Concrete stone FickI b. Basementtype: full CGrawispace slab other c. Basementfloor: dint stone other d. Basementfloor: Cimcovered> covered covered with e. Concrete floor: gastaled ealed sealed with _ AT f. Foundation walls: Hoedlock stone other g. Foundation walls: unsealed led? sealed with h. The basementis: wet in? dry moldy i. The basementis: finished Rished partially finished j. Sump present? GON TARA“ foor k. Water in sump? GN / not applicable Basement/Lowest level depth below grade: 2% (feet) (ss np Roseucy 20° beer) Identify potential soil vapor entry points and approximatesize (e.g., cracks, utility ports, drains) (prati tunes FREE OF (Ake CRACKS, Ehlena For, Sume Frock. PrhWS PerzarriAt Sue Aeon twrey Locarows 6. HEATING, VENTING and AIR CONDITIONING(Circle all that apply) Type of heating system(s) used in this building: (circle all that apply — note primary) Hotair circulation Heat pump Hot water baseboard Space Heaters ndi Radiant floor Electric baseboard Wood stove Outdoor wood boiler Other The primary type of fuel used is: Natural Gas Fuel Oil Kerosene E Propane Solar ood Coal Domestic hot water tank fueled by: Stream Boiler/furnace located in: Basement Outdoors Main Floor Other Steam Pirep Im Air conditioning: Central Air Open Windows None 035911807 Appendix A.doc

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Page 4 Are there air distribution ducts present? Y 6) Describe the supply and cold air return ductwork, and its condition where visible, including whether there is a cold air return and the tightness of duct joints. Indicate the locations on the floor plan diagram. NoDecor Woe i smau VenTilamev Venrs Nun Tors of WALD 9 bisunn Leven 7. OCCUPANCY _ O’LY Bonpine MANTELTOL Is basement/lowest level occupied? Full-time AEasionsly Seldom Almost Never Level General Use of Each Floor(e.g., familyroom, bedroom, laundry, workshop,storage) Basement Comacror Lon Tan Em Senat ; TANI E m 1s: Floor Liane ps CES 2nd Floor Zes IDG ASL > 3ra Floor as Dee > 44 Floor — 5 Lea { Pe rule 5 8. FACTORS THAT MAY INFLUENCE INDOORAIR QUALITY a. Is there an attached garage? Y ¡> b. Does the garage have a separate heating unit? Y /N/ Ca) c. Are petroleum-powered machines or vehicles Y/N/ EN stored in the garage (e.g., lawnmower,atv, car) Please specify d. Hasthe building ever hada fire? Yv /Ghnen? vla e. Is a kerosene or unvented gas space heater present? Y Where? N f. Is there a workshop or hobby/craft area? Y & Where & Type? si g. Is there smoking in the building? Y fe How frequently? Bor Sree Happens h. Have cleaning products been used recently? An When & Type? Deny i. Have cosmetic products been used recently? Y/ © When & Type? Mor Glenn Levee E pumas Samy Imprerep Men (kr 2012 — 035911807 Appendix A.doc 3 - y f WATER ACROSS SITE.

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Page 5 j. Has painting/staining been donein the last 6 months? E /N Where & When? Ouéy+ Ue . * . . “— k. Is there new carpet, drapes or other textiles? Y DO Where & When? 1. Have air fresheners been used recently? YN When & Type? Dedcy m. Is there a kitchen exhaust fan? Y / ® If yes, where vented? 5] A n. Is there a bathroom exhaust fan? Y / N If yes, where vented?__ Pp | Ar o. Is there a clothes dryer? Y © If yes, is it vented outside? Y / N pl a p. Has there been a pesticide application? Y © When & Type? N| A Are there odorsin the building? DD N If yes, please describe: TES e - in Compienoe feo SN Doany of the building occupants use solvents at work? Ww N (e.g., chemical manufacturing or laboratory, auto mechanic or auto body shop, painting, fuel oil delivery, boiler mechanic, pesticide application, cosmetologist î . UN If yes, what types of solvents are used? Ho vst How Dewants If yes, are their clothes washed at work? Y RO Do any of the building occupants regularly use or work at a dry-cleaning service? (Circle appropriate response) Yes, use dry-cleaning regularly (weekly) Yes, use dry-cleaning infrequently (monthly or less) aan Yes, work at a dry-cleaning service Is there a radon mitigation system for the building/structure? Y /N Date of Installation: &| Is the system active or passive? Active/Passive & | Or 9, WATER AND SEWAGE Water Supply: ubli Drilled Well Driven Well Dug Well Other: Sewage Disposal: ublic Sewer ) Septic Tank Leach Field Dry Well Other: AA 10. RELOCATION INFORMATION(foroil spill residential emergency) a. Provide reasons why relocation is recommended: b. Residents choose to: remain in home relocate to friends/family relocate to hotel/motel c. Responsibility for costs associated with reimbursement explained? Y/N d. Relocation package provided and explainedto residents? Y/N 035911807 Appendix A.doc

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Page 6 11. FLOOR PLANS Draw a plan view sketch of the basement and first floor of the building. Indicate air sampling locations, possible indoor air pollution sources and PID meter readings. If the building does not have a basement, please note. Basement: Goud Freed Y err THK PIT. First Floor: VATU U PMT Ire 035911807 Appendix A.doc

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Page 7 12. OUTDOOR PLOT Draw a sketch of the area surrounding the building being sampled. If applicable, provide information on spill locations, potential air contamination sources (industries, gas stations, repair shops, landfills, etc.), outdoor air sampling location(s) and PID meter readings. Also indicate compass direction, wind direction and speed during sampling, the locations of the well and if a and a qua statement to locate the site on a map. 035911807 Appendix A.doc

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Page 8 13. PRODUCT INVENTORY FORM Make & Modelof field instrument used: Pra Pura List specific products found in the residence that have the potential to affect indoor air quality. Location Descri Size Condition* Chemical Field Photo** (units) Ingredients Instrument YIN Reading (units * Describe the condition of the product containers as Unopened (UO), Used (U), or Deteriorated (D) ** Photographs of the front and back of product containers can replace the handwritten list of chemical ingredients. However, the photographs must be of good quality and ingredient labels must be legible. 035911807 Appendix A.doc

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140 Avenue D NEW YORK STATE DEPARTMENT OF HEALTH INDOOR AIR QUALITY QUESTIONNAIRE AND BUILDING INVENTORY CENTER FOR ENVIRONMENTAL HEALTH This form must be completed for each residence involved in indoorair testing. Preparer’s Name aro id Churano Date/Time Prepared 3/ LS | ¿35 1000 Am Preparer’s Affiliation Der ADI 4 PhoneNo. SBS ~ BSO- 14 Tao Purpose of Investigation “Ts DOC Ë Ah e. S ANNP u hole 1. OCCUPANT: Interviewed: Y AD Last Name: First Name: Address: County: Home Phone: Office Phone: Number of Occupants/personsat this location Age of Occupants 2. OWNER OR LANDLORD: (Check if same as occupant __) CAP TARO 6, Interviewed DI N Last Name: 0 PAT First Name: formo Y Address: 4SY Cher Io a County: Man Arm Home Phone: Office Phone: 242—- 278 - 2160 3. BUILDING CHARACTERISTICS Type of Building: (Circle appropriate response) (Residential 5 School Commercial/Multi-use Industrial Church Other: 035911807 Appendix A.doc

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Page 2 If the property is residential, type? (Circle appropriate response) Ranch 2-Family 3-Family Raised Ranch Split Level Colonial Cape Cod Contemporary Mobile Home Duplex Aa Townhouses/Condos Modular Log Home Other: If multiple units, how many? (26 Us rms If the property is commercial, type? Business Type(s) > | Pr Doesit include residences(i.e., multi-use)? Y / N If yes, how many? sa Other characteristics: = Numberof floors Ì > Building age“lo OYAS Is the building insulated¥p/ N How air tight? Tight /& re 4. AIRFLOW Use air current tubes or tracer smoketo evaluate airflow patterns and qualitatively describe: irflow between floors None (No ie Die. {Moviment UNLESS THeou do 4 ees im PAPES Sl Cen PALTOR cuore OL PUO SES, ° ' Airflow near source, . Ae Nenys | Fons Presento. Tiny Recon (on ra ı us Aa Ceramic. Aye imenaioni. Campacopi TEASH Chord. COípres Aito . Outdoorair infiltration Fae C@tttee ia icraneca IP TAN Reem, DEIN Deo ws CREATE ixchanee Wire Ambient da Te In into air ducts Pre Wars asen x 035911807 Appendix A.doc

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Page 3 5. BASEMENT AND CONSTRUCTION CHARACTERISTICS (Circle all that apply) a. Above grade construction: wood frame Crete” stone Brick) b. Basement type: full Aspar slab other c. Basement floor: Concrete dirt stone other d. Basementfloor: ucovered covered covered with e. Concrete floor: sealed sealed with f. Foundation walls: red stone other g. Foundation walls: unsealed Gealed sealed with TAI NT h. The basementis: wet «edamp> dry moldy i. The basementis: finished partially finished j. Sump present? GN Some AN TTRPoen k. Water in sump? Cy, N / not applicable Basement/Lowest level depth below grade: 20 (fect) 4 UMP LN THR Boom Identify potential soil vapor entry points and approximatesize (e.g., cracks, utility ports, drains) _, (pnts oro Stem To be Etec ce Lees (RACKS. Gamers Floor IN (ADs SPACE, DIRINE Portal Entry . INT, 6. HEATING, VENTING and AIR CONDITIONING (Circle all that apply) Poi Typeof heating system(s) used in this building: (circle all that apply — note primary) Hotair circulation Heat pump Hot water baseboard Space Heaters radiation Radiantfloor Electric baseboard ood stove Outdoor wood boiler Other The primary type of fuel used is: Natural Gas Fuel Oil Kerosene Propane Solar Wood Coal Domestic hot water tank fueled by: STEAM Boiler/furnacelocated in: Basement Outdoors Main Floor Other “TEAM TIP ED ¡MW Air conditioning: Central AirWindowpl Open Windows None 035911807 Appendix A.doc

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Page 4 Are there air distribution ducts present? Y ÍN) Describe the supply and cold air return ductwork, andits condition wherevisible, including whetherthere is a cold air return andthe tightness of duct joints. Indicate the locations on the floor plan diagram. aros Ciara Arie Exectane& 7. OCCUPANCY Use RKERS Is basement/lowest level occupied? Full-time Reasionaliy? Seldom Almost Never Level General Use of Each Floor(e.g., familyroom, bedroom, laundry, workshop,storage) Basement MV Core Em , Compacioe Km, Tank Rm . 1st Floor GRADENLs 2na Floor x St DEAMES 3ra Floor Kas 1D Gensl<eS 4 Floor Pes PLUS 8. FACTORS THAT MAY INFLUENCE INDOORAIR QUALITY a. Is there an attached garage? Y KD b. Does the garage have a separate heating unit? Y/N/ XA c. Are petroleum-powered machines or vehicles Y/N/ CA stored in the garage (e.g., lawnmower, atv, car) Please specify__ Yu | YA d. Has the building ever had a fire? Y/ nen? NI A e. Is a kerosene or unvented gas space heater present? Y nere? N| A f. Is there a workshop or hobby/craft area? Y fw Where & Type? SIA g. Is there smoking in the building? Y ISD How frequently? ‘Pte pit Smi Do h. Have cleaning products been used recently? EN When & Type? D ALY i. Have cosmetic products been used recently? Y/iWhen & Type? N] fr X morra Say er 2012 3-4) Waren seg “Tyo Cy a 035911807 Appendix A.doc KRESS i HE STE

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Page 5 > j. Has painting/staining been donein the last 6 months? Gn Where & When? | Duct U Ps k. Is there new carpet, drapes or other textiles? Y/ > Where & When? N la 1, Have air fresheners been used recently? WW N When & Type? Da LY m. Is there a kitchen exhaust fan? Y 19) If yes, where vented?_N | A n. Is there a bathroom exhaust fan? Y Ap If yes, where vented? A] A o. Is there a clothes dryer? O Y/ U If ves, is it vented outside? Y/N A}A vi p. Has there been a pesticide application? Y ARD When & Type? © A Are there odorsin the building? ED N If yes, please describe: Tas y SELL jh (mp 4 CTO dd. Kees N Do any of the building occupants use solvents at work? Cè; N (e.g., chemical manufacturing or laboratory, auto mechanic or auto body shop,painting, fuel oil delivery, boiler mechanic, pesticide application, cosmetologist If yes, what types of solvents are used? Hous Siro CD Crean RS If yes, are their clothes washed at work? Y/O Do anyofthe building occupants regularly use or work at a dry-cleaning service? (Circle appropriate response) Yes, use dry-cleaning regularly (weekly) No Yes, use dry-cleaning infrequently (monthly or less) nknow Yes, work at a dry-cleaning service Is there a radon mitigation system for the building/structure? Y /N Date of Installation: N|A Is the system active or passive? Active/Passive #& la 9. WATER AND SEWAGE Water Supply: Drilled Well Driven Well Dug Well Other: —_— Sewage Disposal: / Septic Tank Leach Field Dry Well Other: 10. RELOCATION INFORMATION(for oil spill residential emergency) a. Provide reasons whyrelocation is recommended: b. Residents choose to: remain in home relocate to friends/family relocate to hotel/motel c. Responsibility for costs associated with reimbursement explained? Y/N d. Relocation package provided and explained to residents? Y/N 035911807 Appendix A.doc

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Page 6 11. FLOOR PLANS Draw a plan view sketch of the basement andfirst floor of the building. Indicate air sampling locations, possible indoorair pollution sources and PID meter readings. If the building does not have a basement, please note. AID Of 7 AA- 032613 AVENVE First Floor: C4 >= - con Tined opa 035911807 Appendix A.doc a_ . DF tan Draun

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Page 7 12. OUTDOOR PLOT Draw a sketch ofthe area surrounding the building being sampled. If applicable, provide information on spill locations, potential air contamination sources(industries, gas stations, repair shops, landfills, etc.), outdoor air sampling location(s) and PID meter readings. Also indicate compass direction, wind direction and speed during sampling, the locations of the well and septic ifa ble, and a qu statement to help locate the site on a hic map. 035911807 Appendix A.doc

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Page 8 13. PRODUCT INVENTORY FORM Make & Modelof field instrument used: List specific products found in the residence that have the potential to affect indoor air quality. Location uct Descri Size Condition* Chemical Field Photo** (units) Ingredients Instrument Y/N units LACS DEN * Describe the condition of the product containers as Unopened (UO), Used (U), or Deteriorated (D) ** Photographs ofthe front and back of product containers can replace the handwritten list of chemical ingredients. However, the photographs must be of good quality and ingredient labels mustbelegible. 035911807 Appendix A.doc

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NEW YORK STATE DEPARTMENT OF HEALTH INDOORAIR QUALITY QUESTIONNAIRE AND BUILDING INVENTORY CENTER FOR ENVIRONMENTAL HEALTH This form must be completed for each residence involved in indoorairtesting. Preparer’s Name Aron (au Mind Date/Time Prepared 3] 25| ig jo:co Aw Preparer’s Affiliation ARLADAS Phone No. 9OS- GBO- I4SE Purposeof Investigation 1. OCCUPANT: Interviewed: Y (0 Last Name: First Name: Address: County: HomePhone: Office Phone: Number of Occupants/personsat this location Age of Occupants 2. OWNER OR LANDLORD: (Check if same as occupant __) IntervieweadCN) Last Name: CMain First Name: Arte ary Address: ‘st Casy 1b TH orneer County: Man erred HomePhone: Office Phone: 212-216 -:- 2450 3. BUILDING CHARACTERISTICS Typeof Building: (Circle appropriate response) Residential) School Commercial/Multi-use Industrial Church Other: 035911807 Appendix A.doc

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Page 2 If the property is residential, type? (Circle appropriate response) Ranch 2-Family 3-Family Raised RanchSplit Level Colonial Cape Cod Contemporary Mobile Home Duplex partme e Townhouses/Condos Modular Log Home Other: If multiple units, how many? IZ vas If the property is commercial, type? Business Type(s) | x Doesit include residences(i.e., multi-use)? Y / Or yes, how many? ShiAr Other characteristics: Number of floors | 3 Building age “los YRS Is the building insulated(YY N Howair tight? Tight / cago) Not Tight 4. AIRFLOW Use air current tubes or tracer smoke to evaluate airflow patterns and qualitatively describe: Airflow between floors ORE — Ne detincato fio Meu tment UNicss Fogo id GAPS IN PPE in Fico , Comrncret (Hurt | DL eis ywere te TSUET \ Airflow near source Some Air Nery | Cas fans on Tank Ree rm CERA Pr Leune Outdoor air infiltration . — Fen CheetTes Omprrr Me PKR fa Cine Ro DA, (pers Doves Piso LAT AQ ebano, Infiltra tration rene air an No TS LO Tien cr FIRST Etsoe (ploon p Lever 035911807 Appendix A.doc

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Page 3 5. BASEMENT AND CONSTRUCTION CHARACTERISTICS (Circle all that apply) a. Above grade construction: wood frame ofñcrely stone brick b. Basementtype: full awlspaze slab other c. Basementfloor: stone other d. Basement floor: covered covered with e. Concrete floor: asealed”sealed sealed with f. Foundation walls: block stone other g. Foundation walls: unsealed Caledsealed with Pu ni TT h. The basementis: wet Amp _ dry moldy i. The basementis: finished finished) partially finished j. Sump present? Cy, N k. Water in sump? Gl N/ not applicable Basement/Lowest level depth below grade: Zo (feet) ¿A So mp Identify potential soil vapor entry points and approximatesize (e.g., cracks, utility ports, drains) Qpuctese Armes fippega Fees se Cencas . Tacna fico ds AÑ DLANUS Portrait SOUL iPod Sn TRY Po nt 6. HEATING, VENTING and AIR CONDITIONING(Circle all that apply) Type of heating system(s) used in this building: (circle all that apply — note primary) Hotair circulation Heat pump Hot water baseboard Space Heaters : Radiant floor Electric baseboard Woodstove Outdoor wood boiler Other The primary typeof fuel used is: Natural Gas Fuel Oil Kerosene TC Propane Solar Wood Coal Domestic hot water tank fueled by: STAN, Boiler/furnace located in: Basement Outdoors Main Floor Other SLAM YıreD (AV Air conditioning: Central Air dorun Open Windows None 035911807 Appendix A.doc

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Page 4 Are thereair distribution ducts present? Y© Describe the supply and cold air return ductwork, and its condition where visible, including whetherthere is a cold air return and the tightness of duct joints. Indicate the locations on the floor plan diagram. No Deer Werk “PRESewT , Wants AND Cares Located AN TANG Roan 7. OCCUPANCY Dorm ets Is basement/lowest level occupied? Full-time AEasional)y Seldom Almost Never Level General Use of Each Floor (e.g., familyroom, bedroom, laundry, workshop,storage) Basement Tp Ken wn y Paard Ree n Comp Pret Em laFloor [3 WesyPen~ces Pvertoi Rim 2s0Ftoor- ra Floor 4urFleer 8. FACTORS THAT MAY INFLUENCE INDOORAIR QUALITY a. Is there an attached garage? Y KD b. Does the garage have a separate heating unit? Y/N/ND c. Are petroleum-powered machinesor vehicles Y/N/ a stored in the garage(e.g., lawnmower,atv, car) Please specify = | A d. Has the building ever had a fire? Y /KWhen? N|a e. Is a kerosene or unvented gas space heater present? Y ISWhere? N| A f. Is there a workshop or hobby/craft area? ( YYN Where & Type? Pasen Aer A g. Is there smokingin the building? Y TO) How frequently? Drive Do h. Have cleaning products been used recently? fy N When & Type? | > AiLy brWERAL i. Have cosmetic products been used recently? Y/ NWhen & Type? (5 Luo dv 3 U CRICANE Sanpy 3-4! ¡E Resi erts DI OE ATG ACQ0SS Gea 035911807 Appendix A.doc

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Page 5 j. Has painting/staining been donein the last 6 months? (vy N Where & When? uc Ups k. Is there new carpet, drapesor othertextiles? Y SD Where & When? p| A I. Have air fresheners been used recently? EN When & Type? Drrioy m. Is there a kitchen exhaust fan? y /® if yes, where vented? N| 4 n. Is there a bathroom exhaust fan? Y/ Pr yes, where vented? N| A o. Is there a clothes dryer? VID If yes, is it vented outside? Y/N”./ a p. Has there been a pesticide application? Y/ O When & Type? N| A Are there odorsin the building? Lo N If yes, please describe: TT RHS t SMELL in CONPAECTOR Ate mn Do any of the building occupants use solvents at work? O) N (e.g., chemical manufacturing or laboratory, auto mechanic or auto body shop,painting,fuel oil delivery, boiler mechanic, pesticide application, cosmetologist If yes, what types of solvents are used? Keuss HOLD C DEA EIA If yes, are their clothes washed at work? Y IR) Do anyof the building occupants regularly use or work at a dry-cleaning service? (Circle appropriate response) Yes, use dry-cleaning regularly (weekly) No Yes, use dry-cleaning infrequently (monthly orless) known Yes, work at a dry-cleaning service Is there a radon mitigation system for the building/structure? Y Nate of Installation: Nj 4 Is the system active or passive? Active/Passive NM # 9, WATER AND SEWAGE Water Supply: Publi Drilled Well Driven Well Dug Well Other: Sewage Disposal: Public Sew Septic Tank Leach Field Dry Well Other: 10. RELOCATION INFORMATION(foroil spill residential emergency) a. Provide reasons why relocation is recommended: b. Residents choose to: remain in home relocate to friends/family relocate to hotel/motel c. Responsibility for costs associated with reimbursement explained? Y/N d. Relocation package provided and explained to residents? Y/N 035911807 Appendix A.doc

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Page 6 11. FLOOR PLANS Draw a plan view sketch of the basementand first floor of the building. Indicate air sampling locations, | possible indoorair pollution sources and PID meter readings.If the building does not have a basement, | note. 7 foor % 44 (acu Ape e | First Floor: 035911807 Appendix A.doc

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Page 7 12. OUTDOOR PLOT Draw a sketch of the area surrounding the building being sampled. If applicable, provide information on spill locations, potential air contamination sources (industries, gas stations, repair shops, landfills, etc.), outdoor air sampling location(s) and PID meter readings. Also indicate compass direction, wind direction and speed during sampling, the locations of the well and septic ifa anda statement to heip locate the site on a t map. 035911807 Appendix A.doc

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Page 8 13. PRODUCT INVENTORY FORM Make & Model offield instrument used: DP B RA E List specific products found in the residence that have the potential to affect indoor air quality. Location Descri Size Condition* Chemical Field Photo** (units) Ingredients Instrument YIN Reading (units El GS * Describe the condition of the product containers as Unopened (UO), Used (U), or Deteriorated (D) ** Photographsof the front and back of product containers can replace the handwritten list of chemical ingredients. However, the photographs must be of good quality and ingredient labels mustbe legible. 035911807 Appendix A.doc

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MAL FDR Dave NEW YORK STATE DEPARTMENT OF HEALTH INDOOR AIR QUALITY QUESTIONNAIRE AND BUILDING INVENTORY CENTER FOR ENVIRONMENTAL HEALTH This form must be completed for each residence involved in indoorairtesting. Preparer’s Name An eon Cauze and Date/Time Prepared 3] 2.5]| iz ¡0:00 Hm Preparer’s Affiliation Acad id Phone No. Purpose of Investigation | Noe a Ay A Han Pra 1. OCCUPANT: Interviewed: Y (N) Last Name: First Name: Address: County: Home Phone: Office Phone: Number of Occupants/personsat this location Age of Occupants 2. OWNER OR LANDLORD: (Check if same as occupant _) Interviewed(y) N Su? ERAN SEC Last Name: Parr ¿Qe First Name: 4 AITHE MS Y Address: 4S4 Gs TC lor Sr Qt County: Maw Were HomePhone: Office Phone: +14 - LAR - A400 3. BUILDING CHARACTERISTICS Type of Building: (Circle appropriate response) (Residensia School Commercial/Multi-use dustrial Church Other: 035911807 Appendix A.doc

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Page 2 If the property is residential, type? (Circle appropriate response) Ranch 2-Family 3-Family Raised Ranch Split Level Coloniai Cape Cod Contemporary Mobile Home Duplex Apartment House> Townhouses/Condos Modular Log Home Other: If multiple units, how many? | \ + V na TS If the property is commercial, type? Business Type(s) N] Pr F Doesit include residences(i.e., multi-use)? Y /N If yes, how many? _M | h Other characteristics: Numberoffloors | 2 Building age+ las o> y Ls Is the building insulatedXY) N How air tight? Tight / (Ga / Not Tight 4. AIRFLOW Use air current tubes or tracer smoke to evaluate airflow patterns and qualitatively describe: Airflow between floors ons Ne Neemose Ait Pus ness “Tove Y avo UN Mpınoe (oMmPAcTOR Komm TARSH (Huye oR DANSTO RS MPT 7 Airflow near source COME MENTS Fans, TAK Peon Fans (len MR TE CA Mi. ! Outdoorair infiltration . Faws (a veder Amsızur Ave Cet kAnwse And Open “MOORS 127 yaw AmBria rr Ait Infiltration into air ducts Me Me Divers Iper DO GROND Laver. 035911807 Appendix A.doc

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Page 3 5. BASEMENT AND CONSTRUCTION CHARACTERISTICS(Circle all that apply) a. Above grade construction: wood frame Cnerste stone brick” b. Basement type: full Kawlepate slab other c. Basement floor: edficrete Ar stone other d. Basement floor: uncovered covered covered with e. Concrete floor: «caida sealed sealed with f. Foundation walls: ute ck stone other g. Foundation walls: unsealed Sealed) sealed with nint h. The basementis: wet amp) dry moldy i. The basementis: finished (iifinished partially finished j. Sumppresent? CLAN k. Water in sump? GON / not applicable Basement/Lowestlevel depth below grade: / e (feet) TPAK Loom Sum P Identify potential soil vapor entry points and approximate size (e.g., cracks, utility ports, drains) Copure re Looks Appare as BAL Ce@tevs | . ZALA Fier pauDears Peren Sti Vapor Poin TS. 6. HEATING, VENTING and AIR CONDITIONING (Circle all that apply) Type of heating system(s) used in this building: (circle all that apply — note primary) Hotair circulation Heat pump Hot water baseboard Space Heaters eam radiati Radiantfloor Electric baseboard Woodstove Outdoor wood boiler Other The primary type of fuel used is: Natural Gas Fuel Oil Kerosene ectrië Propane Solar Wood Coal Domestic hot water tank fueled by: Grzer AA Boiler/furnace located in: Basement Outdoors Main Floor Other PTCAN FI Ped iv Air conditioning: Central Air ona Open Windows None 035911807 Appendix A.doc

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Page 4 wo Are there air distribution ducts present? Y N) Describe the supply and cold air return ductwork, and its condition where visible, including whether there is a cold air return andthe tightness of duct joints. Indicate the locations on the floor plan diagram. Ne DUT WEC AAT ener? Gears AWD FANS leo im Taw Recon. 7. OCCUPANCY a. OLLAS Is basement/lowest level occupied? Full-time Gekisionstly Seldom Almost Never Level General Use of Each Floor (e.g., familyroom, bedroom, laundry, workshop, storage) Basement MT Ren (e MPACTER- Bm . Lane Roe on lsFloor 7 \ > Pe & (DF we CS 2uiFfoor ra Floor 4Floor 8. FACTORS THAT MAY INFLUENCE INDOORAIR QUALITY a. Is there an attached garage? YA b. Does the garage havea separate heating unit? Y/N/ XA c. Are petroleum-powered machinesor vehicles Y/N/K® stored in the garage (e.g., lawnmower, atv, car) Please specify AJ | & d. Has the building ever had fire? Y /6OWhen? IA e. Is a kerosene or unvented gas space heater present? Y / Where? N Ik f. Is there a workshop or hobby/craft area? Y/ RD Where & Type? As | A g. Is there smoking in the building? Y/AHow frequently? on La Happaus h. Have cleaning products been used recently? G /N When & Type? D AN Y i, Have cosmetic products been used recently? Y Owhen & Type? + Horses Gand Cer ZO 3-4! ware Across Sive 035911807 Appendix A.doc

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Page 5 j. Has painting/staining been donein the last 6 months? GON Where & When? [euzu B)IE k. Is there new carpet, drapes or other textiles? Y/ © Where & When? >| 9 I. Have air fresheners been used recently? Q /N When & Type? \ el \ Y m. Is there a kitchen exhaust fan? Y / Bo If yes, where vented? AS Î A om 4 n. Is there a bathroom exhaustfan? Y/NIf yes, where vented? nv] & o. Is there a clothes dryer? YIIf yes, is it vented outside? Y/N A]4 p. Has there been a pesticide application? Y (N When & Type? N/ A Are there odors in the building? Wi N If yes, please describe: Tías it sm ELL CRD mM Combaero YA Do any of the building occupants use solvents at work? DI N (e.g., chemical manufacturing or laboratory, auto mechanic or auto body shop,painting, fuel oil delivery, boiler mechanic, pesticide application, cosmetologist If yes, what types of solvents are used? Mo OS E HOLD OaseS If yes, are their clothes washed at work? Y€ Do any of the building occupants regularly use or work at a dry-cleaning service? (Circle appropriate response) Yes, use dry-cleaning regularly (weekly) No Yes, use dry-cleaning infrequently (monthly orless) (Cron Yes, work at a dry-cleaning service Is there a radon mitigation system for the building/structure? Y date of Installation: D | A- Is the system active or passive? Active/Passive »j a 9. WATER AND SEWAGE Water Supply: Drilled Well Driven Well Dug Well Other: _ Sewage Disposal: Septic Tank Leach Field Dry Well Other: 10, RELOCATION INFORMATION(for oil spill residential emergency) a. Provide reasons whyrelocation is recommended: b. Residents choose to: remain in home relocate to friends/family relocate to hotel/motel c. Responsibility for costs associated with reimbursement explained? Y/N d. Relocation package provided and explained to residents? Y/N 035911807 Appendix A.doc

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Page 11. FLOOR PLANS ; >= ; Bldg 1141 Draw a plan view sketch of the basement and fi F of the building. Indicate air sampling locations, possible indoor air pollution sources and PID meter readings. If the building does not have a basement, ; | please note. Vai AR DHL? | 1 SAMA NI N First Floor: A= aw veut 035911807 Appendix A.doc Da _ elra in. C5= ceutined pdc

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Page 7 12. OUTDOOR PLOT Draw a sketch of the area surrounding the building being sampled. If applicable, provide information on spill locations, potential air contamination sources (industries, gas stations, repair shops, landfills, etc.), outdoor air sampling location(s) and PID meter readings. Also indicate compass direction, wind direction and speed during sampling, the locations of the well and if applicable, and a statementto help locate thesite on a to map. 035911807 Appendix A.doc

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Page 8 13. PRODUCT INVENTORY FORM Make & Modelof field instrument used: DP B RAG i y List specific products found in the residence that have the potential to affect indoor air quality. Location uct Descri Size Condition* Chemical Field Photo** (units) Ingredients Instrument YIN Readi units N CHE M LS fie * Describe the condition of the product containers as Unopened (UO), Used (U), or Deteriorated (D) ** Photographs of the front and back of product containers can replace the handwrittenlist of chemical ingredients. However, the photographs must be of good quality and ingredient labels must belegible. 035911807 Appendix A.doc

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1223 FDR Pewee NEW YORK STATE DEPARTMENTOF HEALTH INDOOR AIR QUALITY QUESTIONNAIRE AND BUILDING INVENTORY CENTER FOR ENVIRONMENTAL HEALTH This form must be completed for each residence involved in indoorairtesting. Preparer’s Name Dios Lear ANO Date/Time Prepared 3] 15| 3 ¡0.ooRwW Preparer’s Affiliation 2cADiS Phone No. S©5- DEO - /4 5G Purpose of Investigation ! Abe e- i e S ATI ELLA lo y 1. OCCUPANT: Interviewed: Y 19, Last Name: First Name: Address: County: Home Phone: Office Phone: Number of Occupants/personsat this location Age of Occupants 2. OWNER OR LANDLORD: (Check if same as occupant __) Interviewed: Y /N Dur CRN DER Last Name: ( NATAL First Name: RN, Address: 4YS4 Casi [OU Snear County: Moro iere? Home Phone: Office Phone: 242--2U% ~ 2 You 3. BUILDING CHARACTERISTICS Type of Building: (Circle appropriate response) Line School Commercial/Multi-use “Industrial Church Other: 035911807 Appendix A.doc

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