Targeted Brownfields Assessment Application

A Targeted Brownfields Assessment is an environmental investigation designed to document environmental conditions at a property under consideration for redevelopment. EPA can provide communities and nonprofit organizations with environmental assessment services at brownfield properties with redevelopment potential. Fill out and submit this form to request a Targeted Brownfields Assessment.

This form is for assessments only in Arizona, California, Hawaii, Nevada, and the Pacific Islands (US EPA, Pacific Southwest region).

Applicant Information
Name of organization(s) or individual(s) requesting Brownfields Assessment
Name and title of the primary contact representing the organization(s) or individual(s) making this request
Primary contact mailing address
Primary contact telephone #
Primary contact fax number
A copy of your application will be sent to this address.
Description of Site
Parcel # of the site to be assessed
(street address, city, state, zip code)
(name, business address, and phone number)
Square feet (if applicable)
(usable, fire damaged, foundation only, partially razed, etc.)
Square feet (if applicable)
(usable, fire damaged, foundation only, partially razed, etc.)
Square feet (if applicable)
(usable, fire damaged, foundation only, partially razed, etc.)
Square feet (if applicable)
(usable, fire damaged, foundation only, partially razed, etc.)
Ownership History and Status
Include: Business Name; Manufacturing/Process Operation; Associated Hazardous Substances
Include: Business Name; Manufacturing/Process Operation; Associated Hazardous Substances
Include: Business Name; Manufacturing/Process Operation; Associated Hazardous Substances
Include: Business Name; Manufacturing/Process Operation; Associated Hazardous Substances
Site Redevelopment
Historic