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Request for Oversight of a Brownfield Site <br /> Phone Number ( ) Fax(_) <br /> Email <br /> Relationship to property: (check one) _current owner or operator_ local <br /> agency_ prospective purchaser developer <br /> other (please describe) <br /> Site Address: <br /> APN Number: Lat/Long (if known) <br /> Summary Information <br /> Evidence that a hazardous material release or discharge occurred: <br /> Description of known or possible human health impact: <br /> Description of known or possible water quality impact: <br /> 2 <br />