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Vn!'1~ ~ <br />• <br />• <br /> <br />Finn <br />Name(s) <br />Doug Stuart Hull & Associates, Inc. <br />Address: (number and street, city, state and ZIP code) <br />3401 Glendale Avenue, Suite 300, Toledo, Ohio 43614 <br />Telephone Number CNI Number Fax Number E-mail Address <br />(419) 385-2018 (419) 385-5487 <br />• <br />Name(s) Flrrn <br />S. Curtis Devoe Plews Shadley Racher & Braun LLP <br />Address: (number and street city, state and ZIP code) <br />1346 North Delaware Street, Indianapolis, Indiana 46202 <br />Telephone Number Cell Number Fex Number E-mail Address <br />(317j 637-0700 (317) 637-0712 cdevoe~psrb.com <br />• , <br />Site or Project Name(s) <br />Millenlum Envirormental, Inc. <br />Address: (number and street city, state and ZIP code) . <br />604 S. Scott Street, South Bend, Indiana 46601 <br />IDEM Site Number US EPA Site Number Size in acxes <br />7100113 IND 980-590-947 <br />Current Owner Address: (number and street city, state and ZIP code) <br />Millenlum Environmental, Inc. 732 Smithtown Bypass, Suite 200, Smithtown, NY 11787 <br />Telephone Number Cell Number E-mail Address <br />Cunant Stetus: (Check a!1 that apply) • <br />QPrivate Owner ^Public Owner ^In Banlwptcy ®Abandoned Inactive ^UndeniUlized (dTax delinquent ^Other (please specify) <br />Environmental Documentation Submitted for Review: (Check a!1 that apply) <br />©Phase 1 Environmental Site Assessment After 11!1/06 must comply with federal All Appropriate Inquiry Rule" ^Phase II Environmental Site Assessment <br />^Sampling Results ^Further Site Chareclerizatlon ^Other (please specify) <br />'contact the Indiana I3rrowntields rem ff have uestlona <br />The Site wilt be: , <br />QSold ^Leased ^Used by governmental entity ^Gifted ^ Other (please specify) ^ Undedded <br />Potential or Intended reuse of property: (Check aN that appy) <br />[~jCommeroial ©Industrial ^Reskienfial QMixed Use ^ Park ^Green Space ^Other (please specify) ^ Undedded <br />Community InvolvementlPublk: Partidpation: (Check all that apply) <br />^Community notification by news media ^Public Meeting(s) ^ Letter(s) of community support ^Community work group <br />^Community Input was not sought <br />How dki you hearabout the Indiana Brownflekls ProgremT (Check al! that apply) <br />Dindiana Brownflelds Program staff, brochure, or web site ©Other State Progrem/Agency ^ EPA ^ Consultant ^Other (please spedfy) <br />1 hereby request an Indiana Brownflalds Program: ©Comfort Letter ^Slte Status Letter <br />Signature of M r zed Representative Date (month, day, year) <br />