ICP Request Property Info

"*" indicates required fields

Superfund Environmental Data Request

Name of Property Owner*

Physical Address of Property*

Street Address Address Line 2 City State ZIP Code

County*

Registered Parcel #*

e.g., D0912341010Z

Information to be released (if available) will be: Remediation Plot Plan, ICP Work Permits and Sample Data.

Information to be released to:

Name*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

How would you like us to respond by:*

Mail

Fax

Requestor acknowledges the following by selecting the check-box below:*

I certify that I am the property owner or an authorized agent of the property owner requesting this information for real estate transaction purposes. As the requestor, I will ensure any environmental data provided through this request will be disclosed to all parties involved.

Comments

This field is for validation purposes and should be left unchanged.