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Brownfields
Pesticides
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Brownfields Program
Note:
If you would prefer not to submit this form electronically,
a paper version is also available
.
Brownfields Information & Assessment Request Form
Note: Fields marked with an asterisk (*) are required.
First Name:
*
Last Name:
*
Phone Number:
*
Street Address:
Address of Property Inquiry (site description):
*
Type of Land:
Tribal
Alotted
Unknown
*
Possible Contamination, Environmental or Health Concerns:
*
Comments or Questions:
*