Form Mo 780-1712 - Brownfields/voluntary Cleanup Program (Bvcp) Application Page 4
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4MISSOURI DEPARTMENT OF NATURAL RESOURCES
HAZARDOUS WASTE PROGRAM – BROWNFIELDS/VOLUNTARY CLEANUP PROGRAM (BVCP)
CONSENT FOR ACCESS TO PROPERTY FORM
SITE INFORMATION
SITE NAME
SITE ADDRESS
OWNER
OPERATOR (IF DIFFERENT FROM OWNER)
ACCESS AGREEMENT
I, as owner/authorized representative of
(“Owner”), authorize officers,
employees, authorized representatives and persons acting at the request of the Missouri Department of Natural
Resources (department) to enter and have access to the above named property at the stated location, for purposes of
oversight of environmental investigation and remediation under the BVCP. Access shall include but not necessarily be
limited to the following activities:
Walkthroughs of the property, buildings, facilities and operations
Evaluation and documentation of site conditions
Verification of information contained in reports submitted to the BVCP
Observation and oversight of sampling, testing, investigation and remediation activities
Collection (and/or splitting) of samples of environmental media including soil, groundwater, waste or building
components
Other actions related to the investigation of hazardous substances under the BVCP
The department ensures that:
Access will be upon reasonable notice, and will be typically (but not necessarily limited to) visits to observe site
work planned and performed by the Owner, BVCP applicant or their contractors or agents, under department-
approved work plans.
Department personnel will follow industry standard health and safety practices appropriate for conditions and will
abide by health and safety directives communicated by Owner or Applicant or their representatives or contractors,
including the use of appropriate personal protective equipment such as hardhats, work boots and safety vests.
Upon completion of the project, any department material and equipment will be removed from the site.
This consent shall expire upon department’s issuance of a certificate of completion for this site, participant’s
withdrawal from BVCP or termination of participation by the department.
This consent shall not be construed as or deemed to be an admission of any fact, responsibility, fault or liability
in connection with the site.
Owner ensures that:
Owner shall hold the department harmless from any claims (including, but not limited to, property damage or
personal injury) arising from activities, reviewed or overseen, by the department under this agreement and which
have been approved by Owner and conducted under Owner’s supervision.
This Access Agreement may be executed in multiple counterparts, each of which will, for all purposes, be deemed
an original, but which together will constitute one and the same instrument.
This Access Agreement is executed by duly authorized personnel of the parties to be effective as
of the_______ day of_________________ 20____ (the “Effective Date").
SIGNATURES
SITE OWNER SIGNATURE
PRINTED NAME/TITLE
DATE
MISSOURI DEPARTMENT OF NATURAL RESOURCES
PRINTED NAME/TITLE
DATE
MO 780-1 713 (03-16 )
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