State Form 49493 - Abandoned Tank Community Assistance Program - Office Of Land Quality Of Indiana Department Of Environmental Management

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Abandoned Tank Community Assistance Program
State Form 49493 (8-99)
Indiana Department of Environmental Management
Office of Land Quality
APPLICATION
Community:
Co-Applicant:
Contact Person:
Phone #:
FAX #:
Address:
County:
Population of community where site located:
Location of property for which assistance is sought:
Legal Description:
Number of tanks on the property:
Previous property owner(s) (list name(s) and current address if known):
Please identify the owner who installed the tanks:
Community obtained ownership of this property through:
9 Tax Delinquency 9 Lien 9 Condemnation 9 Other (Please explain)
Current status of property
Is the property abandoned? 9 Yes 9 No How many years has it been abandoned?
If in use, for what purpose? (Please explain)
What were the tanks used for? (i.e. gas station):
List any known spills, releases, fires and/or other problems at this site:

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