Request for Brownfields Services

1

Services Requested:

• Phase I Environmental Site Assessment
• Phase II Environmental Site Assessment
• Cleanup Planning Analysis of Brownfields Cleanup Alternatives
• Loan for Cleanup
• Reuse Planning

Services Requested: Phase I Environmental Site Assessment Phase II Environmental Site Assessment Cleanup Planning Analysis of Brownfields Cleanup Alternatives Loan for Cleanup Reuse Planning

2

Property Name

Property Name

3

Property Address

Property Address

4

Property Owner

Property Owner

5

Property Size (in acres)

Property Size (in acres)

6

Date current Property owner acquired the site.

Date current Property owner acquired the site.

7

Is there a perspective purchaser?

Is there a perspective purchaser?

Yes

No

8

Perspective Purchaser Name

Perspective Purchaser Name

9

Expected Date of Sale

Expected Date of Sale

10

 How will the property be acquired?

How will the property be acquired?

Bought Outright

Donation

Foreclosure

Eminent Domain

Other

11

 Future Planned Use of Property

Future Planned Use of Property

12

 Why do you believe this property is contaminated?

Why do you believe this property is contaminated?

13

 Is the applicant a nonprofit organization?

Is the applicant a nonprofit organization?

Yes

No

14

 Applicant's name and phone number

Applicant's name and phone number

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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