Brownfields Information Form

Brownfield Information Request Form

This form is used as a pre-screening tool for our Brownfield Administrator. The administrator will contact you for more information.

First Name *

Last Name *

Email Address *

Address of Property *

City *

State *

Zip *

Phone Number *

Are you the current owner? *

Yes

Did you generate any hazardous materials on the property? *

Yes

What is the current status of the property (vacant, in use)? *

What is the age of the building(s)? *

What is the size of the building(s) and how many floors on the property? *

What are the primary environmental concerns on the property? *

What is the previous use of the property? *

What is the size of the lot? *

Is the property tax delinquent? *

Yes

Is a map, aerial photo, or other illustration that shows the outline of the property and its boundaries available? *

Yes

Were there any past environmental reports and/or response actions associated with the property? *

Yes

Are there any other contamination concerns including Asbestos and Lead-Based paint? *

Yes

Is there physical access to the property? *

Yes

Is there a critical deadline or suspense date for completing the assessment? *

Yes

What is the proposed reuse/redevelopment of the property? Please describe in detail. *

If a prospective buyer, please list the name of current owner and date purchased by current owner. *