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NYC-WTC_000199621

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000199621–000199623
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Scanned page image, NYC-WTC_000199623
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NYC 9/11 Public Portal Document

CONSENT FOR ACCESS TO PROPEERTY

Name (print)

Telephone number ()

Description of Property (address)

I hereby consent for employees of the New York City Department of Health (NYCDOH) or parties authorized by NYCDOH, to enter and have reasonable access to the above-described property for the collection of environmental samples.

1 am the property owner or an individual having the consent of the property owner to authorize access to the above-described property.

I give this written permission voluntarily with full knowledge of my right to refuse and without threats or promises of any kind.

Signature Date

Witness: Name Date

Please direct any questions or concerns about this sampling to Chris D’Andrea at the New York City Department of Health, (212) 788-4285.

CITY_21MC1OO_OO3O3 4955

NYC-WTC_000199623

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NYC-WTC_000199623Source: NYC Law Department, mirrored locally

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