WTC Vicinity Building Survey Proposal Background Study Data

NYC 9/11 Public Portal Document

, »

CONSENT FOR ACCESS FOR ENVIRONMENTAL SAMPLING WORLD TRADE CENTER BACKGROUND STUDY

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 79* Street in Manhattan.

The results of the Background Study will be compared with samples taken fi-om apartments in the areas of Manhattan 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 volimteers and their specific residence will be confidential.

I understand that 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 st seq.:

CONSENT

Having considered the information provided on the Background Study, I am willing to volunteer to participate in the study.

I hereby consent to officers, employees and authorized representatives of EPA having access to the residence (“Residence”), identified below, and personal property in the Residence at:

Street Address:

Apartment Number:

to conduct the Background Study, as briefly summarized below.

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.

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_000149923