Manufacturers Assessment


Business Name*

Mailing Address



Address of Location of Concern:

How long have you been operating at this location?

Do you know if someone else operated at this location before/after you?

What type of chemicals or petroleum products have been used at this location?:

Did you ever have any underground storage tanks or above ground storage tanks for fuel, oil, fleet fueling, or process chemical storage?

Do you have use hydraulic lifts in your facility?

Did you ever manufacture metal parts or do metal plating as part of your manufacturing process?

Does your manufacturing involve a large number of pneumatic devices such as plastic presses or other machinery to move or assemble parts?

Did you purchase general liability insurance for your business?

Do you have any of these policies?

Has there been a Phase I conducted?

Has there been a Phase 2 conducted?