Associated Environmental Group, LLC - Site Assessment Checklist

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ESA Checklist

* required information

*Company:
*Name:
Title:
*Address:
*City/State/Postal Code:
*Phone:
Fax:
Email:

Property Information
*Address
*City/State/Postal Code
*County
*Parcel Number
Title History back to 1940 or Description of Property :	Title/Description:
Past/present uses of the property	Uses of property:
Name of current owner/operator of the property
Is there or have there been any known environmental conditions on the property?
If there are, please give a brief description	Conditions:
Are there any environmental liens encumbering the property?