2. 1.  PROPERTY OWN INFORMATION
4. a.  Property Owner Name
6. b.  Property Owner Address
8. c.  Property Owner Phone
9. d.  Property Owner Email
11. e.  How many entities own the property?
12. f.  Is the land publicly or privately owned?
    -- Select One --PublicPrivate
16. 2.   PROPERTY INFORMATION
18. a. Property Name
20. b.   Property Address
22. c.  Tax Map Number(s)
24. d.  Acreage
25. e.  Number of buildings on site
26. Square footage
28. f.  Nmber of underutilized/vacant buildings
30. g.  Age/Condition of buildings.
31. Historical designation?
    -- Select One --YesNo
33. h.  Closest community/city to property?
35. i.  Is the site a Brownfield "real property, the expansion, redevelopment, or reuse of which may be complicated by the presence or potential presence of a hazardous substance, pollutant, or contaminant?"

    1. No
    2. Yes
37. j.  What are the zoning classifications of property?
    -- Select One --ResidentialIndustrialCommercialOther
38. Describe other zoning classification
40. k.  Did you conduct All Appropriate Inquiry or an equivalent Phase I assessment prior to purchase?

    1. Yes
    2. No
41. When/Date
43. Who conducted the All Appropriate Inquiry?
45. l.  Describe the property's operational history and current use(s).
47. m.  Describe your organizations' relationship with all prior owners of the property and any familial, contractual, corporate, or financial relationships or affiliations that or organization may have had with the current or past owners or operators of the property.
49. n.  Did disposal of any hazardous substances occur after you acquired the property?
51. o.  Did you cause, contribute or arrange for the disposal of or release of hazardous substances at the property in any way?

    1. Yes
    2. No
53. p.  How would you characterize the condition of the property at the present time?
55. q.  Check all relevant contaminants onsite:

    1. Controlled Substances
    2. Asbestos
    3. PCBs

    1. VOCs
    2. Lead
    3. PAHs

    1. Radioactive Materials
    2. Petroleum

    1. Other Metals
    2. Other Contaminants
57. Other metals
58. Other contaminants
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

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