Brownfield Site Assessment Request Form

Overview

The WVDEP Office of Environmental Remediation receives funding through the EPA Brownfields Program to conduct environmental site assessments on properties throughout West Virginia. Assessment activities include Phase I Environmental Site Assessments, Phase II Environmental Site Assessments, asbestos inspections, and lead-based paint inspections. These services are provided at no cost, with a WVDEP contractor completing the assessment and the Office of Environmental Remediation overseeing the project. The primary goal of these activities is to assess priority brownfields and return these properties to productive use for redevelopment.

The amount of available funding for assessments varies based on current grant funding, and occasionally funds are unavailable until the next grant funding cycle.

Eligibility

Local government entities and nonprofits are eligible to request a brownfield site assessment for any site, except the following:

Properties listed (or proposed for listing) on the Comprehensive Environmental Response Compensation Liability Act (CERCLA or “Superfund”) National Priorities List

Properties subject to a unilateral administrative order, court order, administrative order on consent, or judicial consent decree issued to or entered into by parties under CERCLA

Properties subject to the jurisdiction, custody, or control of the U.S. government

Request Form

The WVDEP Office of Environmental Remediation developed a Brownfield Site Assessment Request Form to determine project eligibility, obtain certain required information, and prioritize projects among other requests. Applicants should complete the form to the best of their ability and ensure that information provided is thorough and accurate.

Request Submittal

All completed request forms must be e-mailed to DEPBrownfieldsAssessment@wv.gov for processing. The WVDEP Office of Environmental Remediation will provide confirmation of receipt and status of the request. If the project qualifies and funding is available, WVDEP will request a kickoff meeting with the applicant to define work expectations, sampling needs, and timelines.

Brownfield Site Assessment Request Form

Section 1 – APPLICANT INFORMATION
Applicant
Entity Name Entity Name
Address Address	City City	State State	Zip Code Zip Code
Contact
Name Name	Title Title
Office Phone Office Phone	Cell Phone Cell Phone	Email Email

Section 2 – SITE INFORMATION
Identification
Property Name/Description Property Name	Acres (if known) Acres
Address Address	City City	State State	Zip Code Zip Code
Ownership
Property Owner ☐ Applicant ☐ Other (specify): Other
Property Acquisition Date Date	Property Acquisition Type ☐ Purchased ☐ Donation ☐ Tax Foreclosure ☐ Eminent Domain ☐ Other
Redevelopment
☐ In Progress	Provide a description of redevelopment plans.
☐ Imminent	Description
☐ n/a

Section 3 – SITE ASSESSMENT
Suspected Contamination
Describe the property’s current use(s).
Current Use(s)
Describe the property’s operational history.
Operational History
Identify when and how the property potentially became contaminated.
Time of Contamination
What kind of contamination is suspected?
Suspected Contamination
Previous Assessment
Assessment Type ☐ Phase I Environmental Site Assessment	If yes, date:	Date
☐ Phase II Environmental Site Assessment	If yes, date:	Date
☐ Other (specify): Other	If yes, date:	Date
☐ n/a
Requested Assessment
Assessment Type ☐ Phase I Environmental Site Assessment	☐ Asbestos Inspection	☐ Site Reuse / Remedial Planning
☐ Phase II Environmental Site Assessment	☐ Lead-Based Paint Inspection	☐ Other (specify): Name

Section 4 – ELIGIBILITY
Brownfield Definition	Yes	No	Unknown
Is the site a brownfield, “real property, the expansion, redevelopment, or reuse of which may be complicated by the presence or potential presence of a hazardous substance, pollutant, or contaminant”?	☐	☐	☐
Sites Not Eligible for Funding
Is the property listed (or proposed for listing) on the Comprehensive Environmental Response Compensation Liability Act (CERCLA or “Superfund”) National Priorities List?	☐	☐	☐
Is the property subject to a unilateral administrative order, court order, administrative order on consent, or judicial consent decree issued to or entered into by parties under CERCLA?	☐	☐	☐
Is the property subject to the jurisdiction, custody, or control of the U.S. government?	☐	☐	☐
Sites Requiring a Property-Specific Determination
Is the property subject to a planned or ongoing CERCLA removal action?	☐	☐	☐
Has the property been the subject of a unilateral administrative order, court order, an administrative order on consent, or judicial decree, or been issued a permit by the U.S. or an authorized state under CERCLA, the Solid Waste Disposal Act (as amended by the Resource Conservation and Recovery Act (RCRA)), the Federal Water Pollution Control Act (FWPCA), the Toxic Substances Control Act (TSCA), or the Safe Drinking Water Act (SWDA)?	☐	☐	☐
Is the property subject to corrective action orders under RCRA (sections 3004(u) or 3008(h)) and has there been a corrective action permit or order issued or modified to require corrective measures?	☐	☐	☐
Is the property a land disposal unit that has filed a RCRA closure notification under subtitle C of RCRA and is subject to closure requirements specified in a closure plan or permit?	☐	☐	☐
Has the property had a release of polychlorinated biphenyls (PCBs) and is subject to remediation under TSCA?	☐	☐	☐
Has the property received funding for remediation from the Leaking Underground Storage Tank (LUST) Trust Fund?	☐	☐	☐

Section 5 – PRIORITIZATION CRITERIA
Project Readiness	Yes	No	Unknown
Is there an individual, organization, or business that has committed to redevelopment of the property?	☐	☐	☐
Community Benefit
Would development of the property provide greater access to recreational opportunities, parks, or greenspaces?	☐	☐	☐
Would development of the property preserve or encourage preservation of local historical or cultural resources?	☐	☐	☐
Economic Benefit
Would development of the property create jobs?	☐	☐	☐