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NYC-WTC_000199633

Label derived from the City's folder field. The City does not supply document titles.NYC-WTC_000199633–000199635
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NYC 9/11 Public Portal Document

CONSENT FOR ACCESS TO PROPERTY Name (print) Telephone number ()

Description of Property (address)

I hereby consent to 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.

I am the property owner, or an individual having the authorization of the property owner to make this access agreement.

This written permission is given by me 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) 788-4290.

CITY_21MC100_003050319

NYC-WTC_000199635

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NYC-WTC_000199635Source: NYC Law Department, mirrored locally

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