Phase I Environmental Site Assessment Records Request

PHASE I ENVIRONMENTAL SITE ASSESSMENT RECORDS REQUEST

Submittal Form

To request a review of Public Health environmental records, please complete the form below:

Enter at least one (1) property location request.
Attach a vicinity map if vacant land.

Records may only be available from the past 5 years.

REQUESTER CONTACT INFORMATION* = required field

* Requester's Name

Company Name

* Phone No.

( XXX-XXX-XXXX )

* EMail

( XXX@XXXX.XXX )

FAX

PROPERTY DESCRIPTION* = required field

Property 1

Street No.

* Street Name

* City

Zipcode

* Parcel ID

Montgomery County Auditor: www.mcrealestate.org

Previous business name

Add'l descriptive information

Property 2

Street No.

* Street Name

* City

Zipcode

* Parcel ID

Montgomery County Auditor: www.mcrealestate.org

Previous business name

Add'l descriptive information

Property 3

Street No.

* Street Name

* City

Zipcode

* Parcel ID

Montgomery County Auditor: www.mcrealestate.org

Previous business name

Add'l descriptive information

Property 4

Street No.

* Street Name

* City

Zipcode

* Parcel ID

Montgomery County Auditor: www.mcrealestate.org

Previous business name

Add'l descriptive information

Property 5

Street No.

* Street Name

* City

Zipcode

* Parcel ID

Montgomery County Auditor: www.mcrealestate.org

Previous business name

Add'l descriptive information

DATE RANGE FOR RECORDS REQUEST* = required field

* Start Date

( MM/DD/YYYY )

* End Date

( MM/DD/YYYY )

TYPE OF ENVIRONMENTAL RECORDS REQUESTED

ROUTINE LICENSING INSPECTION RECORDS REQUESTED

Restaurant/grocery facilities

School buildings

Manufactured home parks/campgrounds

Motel/hotel facilities

Public pools

Landfills

Select vicinity map to upload:

** Public Health - Dayton & Montgomery County generally has very limited information on buried fuel tanks. Such information may be requested from the Bureau of Underground Storage Tank Regulations, Division of State Fire Marshall at the Ohio Department of Commerce.

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