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

This consent concerns access to the common areas of the building (“Building”) at the following address, for purposes of participation in the World Trade Center Backgroimd Study:

Street Address:

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 and common areas 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.

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 stssUx

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 common areas in the Building, as well as to furniture and carpets that may be in the common areas in the Building. I also consent to the release of the sampling data related to the Building.

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 Building.

I understand that sampling and analysis in the Background Study will be performed as follows:

Air samples will be collected from small pumps running for an eight-hour time period;

Low suction vacuum samples may be collected from locations in the common areas;

NYC-WTC_000149930