Brownfield Site Preliminary Assessment

1. Site Identification

Site Name Site Address City State/Province Zip/Postal Code Site Area (acres/hectares) Site Owner

2. Site History

Previous Land Uses Known or Suspected Contaminants Historical Activities (e.g. manufacturing, storage, dumping)

3. Site Description

Current Site Conditions Existing Structures Adjacent Land Use

4. Environmental Concerns

Contaminated Areas Identified Potential Receptors (e.g. groundwater, population) Noted Environmental Incidents

5. Preliminary Risk Assessment

Potential Human Health Risks Potential Ecological Risks

6. Additional Notes/Comments