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a Return this form to: I`,.,• Indiana Brownfields Program INDIANA BROWNFIELDS PROGRAM \''° Comfort/Site Status Letter Request 100 N. Senate Avenue,Room 1275 State Form 51493(R2/6-07) Indianapolis, IN 46204 Indiana Finance Authority For questions:317-234-1279 Submit form electronically to:browwif-ieldsOlifa.in.eor FAX:317-234-1338 Pursuant to the Indiana Department of Environmental Management(IDEM)Nonrule Policy Document W-0051,"Brownfields Program Comfort and Site Status Letters Policy"(April 18,2003),the Indiana Brownfields Program may issue a Comfort or Site Status Letter to stakeholders at brownfields sites that satisfy the eligibility criteria and conditions of the policy. Brownfield Site Definition A brownfield site is defined as a parcel of real estate that is abandoned or inactive;or may not be operated at its appropriate use; and on which expansion or redevelopment is complicated because of the presence or potential presence of a hazardous substance,a contaminant, petroleum,or a petroleum product that poses a risk to human health and the environment. IC 13-11-2-19.3 Comfort Letter A Comfort Letter is issued to a party that qualifies for an applicable exemption to liability found in Indiana law or IDEM policy, but is not a legal release from liability. The Comfort Letter explains the applicable liability exemption or IDEM's exercise of enforcement discretion under an applicable IDEM policy. Potentially applicable liability exemptions or IDEM policies include: ✓ the Stakeholder is a government entity exempt from liability under IC 13-25-4-8(e), IC 13-11-2-150(c), or IC 13- 11-2-151(b); ✓ the Stakeholder is a creditor, lender,or fiduciary exempt from liability under IC 13-23-13-14, IC 13-24-1-10, or IC 13-25-4-8(c); ✓ the Stakeholder is not the statutory owner of an underground storage tank pursuant to IC 13-11-2-150(a) because the tanks were not used after November 8, 1984 and the Stakeholder was not the person who owned the tank immediately before the discontinuation of the tank's use; ✓ the Stakeholder is exempt from liability or eligible for a defense to liability as a bona fide prospective purchaser, contiguous property owner or innocent landowner pursuant to IC 13-25-4-8(b); and ✓ the Stakeholder satisfies the conditions of IDEM Nonrule Policy Document W-0047,"Property Containing Contaminated Aquifers"(20 IR 1674, January 30, 1997), or IDEM Nonrule Policy Document W-0038"Property Containing Contaminated Aquifers/Underground Storage Tanks"(23 IR 2141,April 20,2000). Site Status Letter A Site Status Letter is issued to a party that did not cause or contribute to or knowingly exacerbate the contamination and can demonstrate that current levels of contaminants of concern at the brownfield substantially meet current cleanup criteria as established by IDEM under the Risk Integrated System of Closure. The potential liability of the party requesting the letter is not addressed. The Site Status Letter states that based on a technical analysis of information submitted to IDEM pertaining to site conditions, IDEM concludes that current site conditions do not present a threat to human health or the environment and that IDEM does not plan to take or require a response action at the brownfield site. INSTRUCTIONS: Please complete this form(type or print legibly)and return it to the Indiana Brownfields Program to begin the process of assessing eligibility to receive a letter. Each request will be reviewed by the Indiana Brownfields Program and IDEM staff. Determinations of eligibility are made based on facts and data provided with the request. A decision on whether or not to issue a Comfort or Site Status Letter will be made approximately 60 days from receipt of the request. The complexity of technical issues pertaining to site conditions may increase staff review time. Please attach any additional documentation required if space on the form does not allow for a complete response. Contact Information Letter Recipient Organization/Community Address:(number and street,city,stale and ZIP code) Telephone Number Cell Number Fax Number Email Address