PERMISSION TO ENTER PROPERTY TO CONDUCTTargeted Brownfield Site Assessments (TBAs) or Site-Specific

Activities (SSAs)Funded under FDEP/EPA Section 128(a) State and Tribal Response

Program CFR - GRANT

1) ("Undersigned"), Owner, hereby gives permission to the State of Florida Department of Environmental Protection ("FDEP") and its agents and contractors to enter the undersigned's property ("the property") located at , Florida.

2) This permission is for the FDEP to conduct TBAs and SSAs and is specifically limited to include the following activities, which may be performed by the FDEP, its agents, representatives, and contractors to evaluate or remove environmental conditions that may be present at the property:

a) To access all areas of the property including areas where environmental contamination may exist;

b) To conduct interviews, take photographs, and create site sketches;

c) To collect soil, groundwater, sediment and air samples necessary to characterize wastes for disposal;

d) To store, remove and dispose investigated-derived wastes;

e) To perform limited source removal actions, which may include the removal of large surface debris items such as containers, waste tires, construction debris, storage tanks, scrap metal, containerized waste, or other agreed upon removal actions; and

f) To use equipment on the property, including vehicles, excavation equipment, and other items, as is necessary to perform the above activities.

3) The granting of this permission by the undersigned is not intended, nor should it be construed, as an admission of liability on the part of the undersigned or the undersigned's

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successors and assigns for any possible groundwater, sediment, air or soil contamination detected in the samples.

4) The FDEP, its agents, representatives or contractors may enter the property during normal business hours and may also make special arrangements to enter the property at other times after agreement from the undersigned.

5) The FDEP acknowledges and accepts its responsibility pursuant to applicable law (Section 768.28, Florida Statutes) for damages caused by the acts of its employees while on the property.

PERMISSION TO ENTER

______________________________________________________Witness Owner

_____________________________________________________Date Date

Accepted by the State of Florida Department of Environmental Protection by the following authorized agent:

______ ___________________________ Witness FDEP Project Manager

_____________________________________________________Date Date

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