Brownfield Site Nomination Form
Calumet County has received a grant from the US EPA that allows us to cover the costs to conduct Phase I and Phase II environmental site assessments at publicly or privately-owned properties within the county that are potentially contaminated. This form helps site owners make us aware of sites they'd like to have considered in this program. Completing this form is not legally binding, nor does it commit the completer to anything. It is just a convenient way to provide many of the important background details. For questions, contact Mary Kohrell at 920-849-1680 or
Submitter Details
Submitted By *
Email *
Phone *
When we follow up to this submission, please specify if you have a preferred date/time of day to be contacted, and if you prefer phone or e-mail.
Submission Site Details
Site Name *
Address *
Apartment, Suite, or Building *
City, State, and Zip Code *
Current Site Owner *
Is there a known contamination at the site? *
If yes, briefly describe
Have any of the following previously been performed?
Phase II ESA? *
If yes, is a report available? *
Environmental Site Investigation? *
If yes, is a report available? *
Environmental Cleanup Activities? *
If yes, is a report available? *
Which of the following would you like performed on this site?
Phase I ESA *
Phase II ESA *
Phase I ESA Update *
I'd like some other analysis performed at this site. *
I don't know what other analysis needs to be performed at this site, and I'd like to talk with someone. *
Summarize why this site is a priority for assessment.
Upon completion of this form, you will be contacted by a member of our team at our earliest convenience.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy