<p> The Kentucky Brownfield Program Recycling the Commonwealth</p><p>Brownfield Inventory Submittal Form</p><p>General Site Information</p><p>County: Address: Property Acreage: Zoning: Sale Price:</p><p>Latitude (if known): </p><p>Longitude (if known): Lat/Long Collection Method: </p><p>Building/ Property Specifics</p><p>Current Use: </p><p>Past Use:</p><p>Building Use Stories Sq. Footage Construction Condition* 1 2 3 4 5</p><p>If there are more than 5 buildings on the property please list them and the site descriptions on a separate sheet of paper. </p><p>* Rating System with examples of typical condition 5- Ready for occupancy 4- Needs mostly cosmetic work 3- Appears structurally sound, but has limited water, fire, vandalism, or similar damage 2- Appears structurally sound, but has significant water, fire, vandalism or similar damage 1- Part or all of the building appears to have significant structural damage Transportation</p><p>Nearest Interstate: Distance to Interstate: Nearest Airport: Distance to Airport: Rail Access: Water/ Port Access: </p><p>Utilities</p><p>Utility Services Available Provider Municipal Yes No Water Gas Yes No Electric Yes No Service Sewer Sewer Septic Unknown Type Broadband Yes No </p><p>Environmental Information</p><p>Status of investigation:</p><p>Known or suspected contamination:</p><p>Status of Remediation:</p><p>Existing environmental or institutional controls: Contact Information</p><p>Contact: Company or Agency: Mailing Address: Phone: E-mail: </p><p>Additional Information</p><p>If available, please attach photographs and maps of your site. Electronic media or CD-ROMs are encouraged. </p><p>Application Submittal Instructions</p><p>Please mail this form to:</p><p>The Kentucky Brownfield Program 300 Fair Oaks Ln. Frankfort, KY 40601 or</p><p>Send via e-mail: [email protected] or</p><p>Fax to: The Kentucky Brownfield Program at 502-564-9720 </p>