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 Background 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 airbome 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 etseq.
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 caipets 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;
NYC-WTC_000163921
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