Previous Environmental Reports and Remedial Actions Disclosure Form
Property Information
Property Address
Owner Name
Environmental Reports
List any previous environmental reports related to the property (e.g., Phase I, Phase II ESA):
Dates of Reports
Entity or Consultant who prepared the Reports
Remedial Actions
Describe any remedial actions undertaken on the property:
Dates of Actions
Regulatory Agency Involved
Outcome/Status of Remediation
Additional Information
Provide any additional information relevant to environmental site history:
Prepared By
Date
Signature