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Brownfield Site Nomination Form

2. Please nominate a brownfield site that you think is a candidate for inclusion in the City of Stevens Point’s U.S. EPA Brownfields Grants Assessment Program.

   Please nominate a brownfield site that you think is a candidate for inclusion in the City of Stevens Point’s U.S. EPA Brownfields Grants Assessment Program.

4. Name*

5. Email Address*

7. Name of the Site (optional)

8. Site Address*

10. Current Site Owner (optional)

12. Is the Site Contaminated?*

    1. Yes
    2. No
    3. I Don't Know

13. If Yes, Please Explain

15. Have any of the following been performed for the site?

    Have any of the following been performed for the site?

17. Phase I ESA*

    1. Yes
    2. No
    3. I Don't Know

18. Phase II ESA*

    1. Yes
    2. No
    3. I Don't Know

20. Environmental Site Investigation*

    1. Yes
    2. No
    3. I Don't Know

21. Environmental Cleanup Activities*

    1. Yes
    2. No
    3. I Don't Know

23. Which of the following would you like performed for the site?

    Which of the following would you like performed for the site?

25. Phase I ESA*

    1. Yes
    2. No
    3. Maybe

26. Phase I ESA Update*

    1. Yes
    2. No
    3. Maybe

27. Phase II ESA*

    1. Yes
    2. No
    3. Maybe

29. Additional Investigation to Define the Nature and Extent of Previously Documented Impacts*

    1. Yes
    2. No
    3. Maybe

30. Asbestos Inspection and/or Assessment for Other Hazardous Building Materials *

    1. Yes
    2. No
    3. Maybe

32. Why is This Site a Priority for Assessment:?

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field