Name*:

Phone*:

Address*:

City*:

State*: Zip*:

Email*:

* I understand that this sample period of noise monitoring is for informational purposes only. The measured noise levels are not synonymous with or used to establish the contours of the BWI Airport Noise Zone and are not used to establish eligibility for any Homeowner Assistance Programs, including the Residential Soundproofing Program.

* I understand that the noise monitoring equipment, especially the microphone cable, is delicate and can be damaged by lawn mowers or other rough use. I agree not to interfere with, cause, or allow any interference with the operation of the equipment. I further agree not to touch or damage the equipment, nor cause the equipment to be touched or damaged. Any such interference, touching or damage to the equipment shall result in the immediate removal of the equipment.

* I will take reasonable safeguards for protecting this equipment while it is on my property.

* I understand and agree that the equipment will be checked periodically to ensure continuous and proper operation, and I agree that access to the equipment will be provided at all times during normal business hours without the necessity of the use of locks, keys, or other obstructions.

* I understand that while in operation a portable noise monitor at my residence may record and store any sounds that exceed certain ambient noise levels. This may include aircraft overflights, road traffic, animals, lawn equipment, conversations, etc.

* I consent to MDOT MAA may operating the portable noise monitor at my property using an outdoor electrical outlet if available and understand that the Owner will not be reimbursed for any such utility use.

* I shall assume all risk incident to or in connection with the installation, use, maintenance, or removal of the portable noise monitoring equipment at my property and I shall indemnify and hold harmless MDOT MAA, its officials, agents, employees, representatives, successors, and assigns, from and against all liability for claims, suits, causes of action, liabilities, losses, costs, or expenses for injuries (including death) to persons or damage (including destruction) to property or the environment, of whatsoever kind or nature, including any claims or fines assessed by a federal agency or any State of Maryland agency, arising directly or indirectly in connection with the installation, use, maintenance, or removal of the portable noise monitoring equipment at my property. This indemnity shall not apply to claims, suits, losses, or damages of whatsoever nature arising out of the negligence or willful misconduct of MDOT MAA, its officials, agents, employees, representatives, successors, or assigns which negligence or willful misconduct is the sole and exclusive cause of said loss, injury or damage.

* I understand that any report prepared based upon my application for a portable noise monitor to be placed at my property will be a public record and that only the Final report will be made available on the MDOT MAA website.

* I understand that by submitting this request and, pending the successful completion of the temporary noise monitoring, I will be ineligible for additional testing for a period of six months from the date of MDOT MAA delivery of the final report.