Phase I Environmental Site Assessment (ESA) Initial Screening Questionnaire

Property & Ownership Information

Property Address

Current Owner

Contact Name

Contact Phone / Email

Describe the current use of the property:

Describe past uses of the property (if known):

Are there any known historical incidents (spills, releases, fires, etc.)? Yes No

Are hazardous materials stored or used on site? Yes No

Are underground storage tanks (USTs) or aboveground storage tanks (ASTs) present? Yes No

Any evidence of spills, stains, or distressed vegetation? Yes No

Describe nearby land uses (e.g., industrial, commercial, residential):

Are there water bodies or wetlands on or near the site? Yes No

Is the site in a floodplain or subject to flooding? Yes No

Other environmental issues, concerns, or comments:

Date Completed

Name/Title of Person Completing