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Headquartered in: Minneapolis, Minnesota Phone: (763) 208-6430 Offices in: Minneapolis, Minnesota Pine River, Minnesota Eau Claire, Wisconsin Tucson, Arizona Email: info@calthacompany.com <% if instr(request.serverVariables("script_name"),"email") = 0 then %> Receive Regulatory Updates By Email Current Employment Opportunities

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ESA Request Form

1. Services requested I would like a quote to conduct: *
	I don't know - please call me to discuss Phase 1 Environmental Site Assessment (ASTM E 1527-05) Transaction Screening Assessment (ASTM E 1528-00) Site assessment walk-through Lease closure walk-through Quantitative Environmental Liability Assessment (QELA ®) Phase 2 Site Investigation Environmental permit and regulatory compliance assessment General consulting other (explain below) (Select all that apply; use control-click (PC's) or command-click (Mac) to select multiples)
If "other" was selected above, please explain:

2. Location
a) Number of sites:
	Single Site Multiple Sites (list below) *

b) List first (or only) site:
City	*
Address
State	*
Zip code	*

c) If you have multiple sites, how many? (List below with at least the city name, state, and zip code. Separate with carriage returns.)

Note: If initial confidentiality is required, only City location is needed to complete quote

3. Ownership
	I own the Subject Property I do NOT own the Subject Property *
Note: No on-site assessments can be conducted without Owner’s permission.

4. Property (Complete to best of your current knowledge)
a) Type:
	Industrial Commercial Retail Office Multifamily residential Single family residential other (explain below) *
	If "other" was selected above, please explain:
b) Size:
	Land area: acres *
	Floor area: sf
c) History:
	Building(s) constructed in what year(s)?
	Number of buildings
	Any known past uses?
	Any known past owners?

5. Requestor Information
Quote needed by (mm/dd/yy) * Services required completed by (mm/dd/yy) * Company information
Company Name	*
Address	*
City	*
State	*
Zip code	*
Contact information
Name	*
Title	*
Email	*
Phone	*
Fax
Mobile
Address	(if different than above)
City
State
Zip code

Special Instructions:


Any supplemental information:

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