Brownfield Site Application/Consideration Form - West Central Arkansas Planning and Development District

EPA Brownfields Assessment Application/Consideration Form

Date of Application *

Contact Information *

Property Owner
Legal Representative

Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Property Address *

Address Line 1

Address Line 2

City

State

Zip Code

Property Appraiser ID Number *

Parcel Size *

Size of Structures on Site, if applicable *

Is the property currently located within the city limits? *

Property Concerns *

Current Site Use *

Historical Site Use *

Does the property have any known Petroleum use? *

Does the property have any known hazardous substance use? *

the agency specify

Historic Significance of Site *

What are the proposed redevelopment plans, if applicable? *

What is the timeline for redevelopment, if applicable? *

Has the property been involved in any other environmental cleanup programs? *