Dry Cleaner Assessment Form

Please note that all fields with an asterisk* are required.

Name*

Name of cleaners

Mailing Address

City

State / Province

Zip / Postal Code

Phone

Fax

Email*

Address of location of concern

How long have you been operating at this location?

Do you own or lease this property where you operated this shop?
OwnLease

Do you know if someone else operated a dry cleaner at this location either before you or after you?

What type of dry cleaning solvent has been
used at this location?

What type of dry cleaning machines have been used at this location? (transfer, vented dry-to-dry, refrigerated dry-to-dry)

How have you disposed of separator/contact water?

Did you purchase general liability insurance for your business?
YesNo

Do you know what companies issued these policies?

Do you have any of these policies?
YesNo

Do you have any old business records, such as leases, cancelled checks, etc?
YesNo

Additional Notes