Department of Toxic Substances Control
Barbara A. Lee, Director Edmund G. Brown Jr.
Matthew Rodriquez 1001 "I" Street Governor
Secretary for P.O. Box 806
Environmental Protection
Sacramento, California 95812-0806
PROPERTY OWNER CONSENT FOR ACCESS TO PROPERTY
Property Address:
Street Address
City
State Zip Code
Property Owner
Name:
Mailing Address (if
different than above):
Home Phone No.:
Cell Phone No.:
Email Address:
Identity Confirmation (check one): • Driver's License
• California State Identification (ID) Card
• Other (type):
I, the "Property Owner," by virtue of my ownership of the real property identified above, and any structures located on the real property (collectively referred to as the "Property), hereby grant continued access to the Property to the Department of Toxic Substances Control (DTSC), its officers, employees, and authorized representatives, including consultants and contractors, for any or all of the following activities related to DSC's investigation and cleanup of lead contaminated soils in areas surrounding the former Exide Technologies facility located in Vernon, California:
• Remedial investigation, including but not limited to boring through soil; soil sampling, sampling of exterior paint on structures; and sampling of paint chips or flakes found at or on the Property. • Removal and Remedial Action, including but not limited to: removal of grass or other landscaping located above soils; soils movement and excavation; placement of soil/ground covering material; and any other activities necessary for remediation of hazardous substances from the Property. • Restoration and monitoring work, including but not limited to backfilling excavated areas with clean soil; replacement of grass or other landscaping; cleaning activity such as sweeping or washing of exterior areas, and HEPA-filter vacuuming of floors and wiping of surfaces in buildings.
I understand that DTSC needs to obtain access from the legal Property Owner prior to taking any action on the Property. I further understand and acknowledge that my signature below authorizes access to the Property as described in this agreement, and does not affect any other right I hold. 1 acknowledge that all actions by DTSC are undertaken pursuant to its response and enforcement responsibilities under the Carpenter-Presley-Tanner Hazardous Substances Account Act, California Health and Safety Code section 25300 et seq. DTSC shall ensure that its officers, employees, authorized representatives, consultants, and contractors comply with applicable federal, state, and local laws.
I understand that DTSC will not charge me for costs incurred by DTSC or its consultants and contractors for any of the activities described in this agreement.
DTSC will protect the confidentiality of personal information provided on this access agreement to the extent authorized by law. Protected information may include the name(s) and telephone number of the property owner and of any other persons who reside at the Property. The property owners) acknowledges that DTSC may be required to obtain permits for certain activities authorized in this access agreement and that the permitting authority may require DTSC to provide the property owner's name and contact information.
DTSC agrees to provide at least two (2) business days advance notice to the undersigned before beginning activities on the Property. DTSC will work with the property owner to coordinate mutually agreeable dates and times for all activities. DTSC agrees to make available to the property owner copies of analytical results and reports obtained from sampling taken on the Property.
I certify that I am the legal owner or authorized agent of the owner of the Property, indicated above, and that I have authority to grant such access. This written permission is given voluntarily, on behalf of myself and all other co-owners of this property, with knowledge of my right to refuse and without threats or promises of any kind. This access is effective on the date of my execution of this agreement, set forth below.
This grant of Property access shall terminate upon DTSC's completion of the activities described in this agreement.
Please mail this signed document to:
Signature (Please sign in ink)
Attention: DTSC - Exide Cleanup Team
Department of Toxic Substances Control
6119 E. Washington Blvd. #120
Date
Commerce, CA 90040
Questions? Please call 844-225-3887