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State of California—California Environmental Protection Agency ) VOLUNTARY <br /> Request for Agency Oversight of a Brownfield Site AAGREEMENTS <br /> Water Boards Supplemental Attachment: California Land Reuse and Revitalization <br /> Act(CLRRA)Application <br /> Please complete this form ONLY if you are an eligible entity applying for a <br /> California Land Reuse and Revitalization Act (CLRRA) Agreement <br /> Definitions of terms used in the CLRRA Application can be found in Article 2 <br /> "Definitions," and Article 6, "Streamlined Site Investigation and Response Plan <br /> Agreements," Chapter 6.82, Division 20 of the Health and Safety Code (commencing <br /> with section 25395.60). <br /> 1. Are you applying as a/an: <br /> ❑ Bona Fide Purchaser (BFP) <br /> ❑ Contiguous Property Owner (CPO) <br /> ❑ Innocent Landowner (ILO) <br /> ❑ Prospective Purchaser (PP) <br /> ❑ Bona Fide Ground Tenant (BFGT) <br /> 2. Is the Site located in a city with a population of greater than 100,000? <br /> Yes ❑ No ❑ <br /> 3. Is the Site solely impacted by petroleum from an underground storage tank and <br /> eligible for reimbursement from the Underground Storage Tank Cleanup Fund? <br /> Yes ❑ No ❑ <br /> If you answered YES to either question 2 or 3, contact a DTSC or Water Board <br /> Brownfield Coordinator to discuss Site-specific details. <br /> 4. Current zoning and planned use of the Site: <br /> 5. Do you own the Site? Yes ❑ No ❑ (If yes, answer questions 6 and 7) <br /> 6. Did the owner conduct due diligence/All Appropriate Inquiries (AAI) prior to <br /> acquiring Site? Yes ❑ No ❑ <br /> If applicable, date AAl was conducted: <br /> 7. Did the owner take reasonable steps with regard to contamination at the Site <br /> including, as appropriate: stopping continuing releases; preventing threatened <br /> releases; and preventing or limiting human, environmental, or natural resource <br /> exposure to earlier hazardous substance releases? Yes ❑ No ❑ <br /> 8. Date the Site was/will be purchased and title was/will be transferred <br /> 9. For Bona Fide Ground Tenant: what is the duration of the lease? <br /> DTSC Form 1460-Revision June 2018 <br /> CLRRA Agreement Supplement <br /> Page 1 <br />