WTC background study and sampling facts distributed, July 2002

NYC 9/11 Public Portal Document

CONSENT FOR ACCESS FOR ENVIRONMENTAL SAMPLING WORLD TRADE CENTER BACKGROUND STUDY

This consent concerns access to the residence (“Residence”) at the following address, for purposes of participation in the World Trade Center Background Study:

Street Address:

Apartment Number

City, State and Zip Code

INTRODUCTION

The United States Environmental Protection Agency (“EPA”) is conducting a background study (“Background Study”) of the constituents in airborne and settled dust in selected residential dwellings north of 59* Street in Manhattan.

The results of the Background Study will be compared with samples taken from apartments in buildings near the collapse of the World Trade Center.

At the conclusion of the investigation, EPA will prepare a report that discusses the findings. The Background Report will be available to the public, but the identity of volunteers will be confidential.

EPA is conducting the Background Study pursuant to its role under the Federal Response Plan and the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121 et seq.

CONSENT

I have read EPA’s Fact Sheet on the Background Study. Having considered the information provided to me about the Background Study, I consent to officers, employees and authorized representatives of EPA having access to the Residence and the personal property located in the Residence. I also consent to the release of sampling data related to the Residence. I understand that the Background Study will be performed by contractors retained by EPA with direct oversight by EPA. The contractors performing the sampling activities are required to maintain insurance coverage for commercial general liability, workers compensation and environmental impairment liability. The contractors are required to maintain such insurance at all times that they are conducting sampling activities in the Residence.

I understand that the Background Study will require access to the Residence and the personal property which is located in various areas of the Residence, including but not limited to the living room, den, bedroom(s), bathroom(s), dining area or dining room, kitchen, and air conditioning/heating units.

NYC-WTC_000138842