"Brownfields Tax Incentive Submittal Form for a Qualified Contaminated Site" - California

Brownfields Tax Incentive Submittal Form for a Qualified Contaminated Site is a legal document that was released by the California Department of Toxic Substances Control - a government authority operating within California.

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Download "Brownfields Tax Incentive Submittal Form for a Qualified Contaminated Site" - California

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U.S. Taxpayer Relief Act - Brownfields Tax Incentive
Submittal Form for a Qualified Contaminated Site
Complete the blanks and check each box below that applies:
Name of Taxpayer: _____________________________________________________
The property is an area at or on which there has been a release (or threat of
release) or disposal of a hazardous substance, as defined by sections 101(14)
and 102 of the Comprehensive Environmental Response, Compensation, and
Liability Act of 1980 (CERCLA), with exception to the limitations in section
104(a)(3).
Attach analytical results or other evidence of a release or threat of
release.
The property is an area at or on which there has been a release (or threat of
release) or disposal of a petroleum product (as defined in section 4612(a)(3)).
Attach analytical results or other evidence of a release or threat of
release.
The Property is NOT a site on or proposed for the EPA National Priorities List
("Superfund" site).
Address of Property:
___________________________________________________
City: __________________________________
County: ___________________
Zip Code: _____________
Name of Submitter: _____________________________________________________
Mailing Address: _______________________________________________________
_______________________________________________________
Phone Number: _______________________________
Fax number: _________________________________
Email Address: ________________________________
Date: ________________________________________
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U.S. Taxpayer Relief Act - Brownfields Tax Incentive
Submittal Form for a Qualified Contaminated Site
Complete the blanks and check each box below that applies:
Name of Taxpayer: _____________________________________________________
The property is an area at or on which there has been a release (or threat of
release) or disposal of a hazardous substance, as defined by sections 101(14)
and 102 of the Comprehensive Environmental Response, Compensation, and
Liability Act of 1980 (CERCLA), with exception to the limitations in section
104(a)(3).
Attach analytical results or other evidence of a release or threat of
release.
The property is an area at or on which there has been a release (or threat of
release) or disposal of a petroleum product (as defined in section 4612(a)(3)).
Attach analytical results or other evidence of a release or threat of
release.
The Property is NOT a site on or proposed for the EPA National Priorities List
("Superfund" site).
Address of Property:
___________________________________________________
City: __________________________________
County: ___________________
Zip Code: _____________
Name of Submitter: _____________________________________________________
Mailing Address: _______________________________________________________
_______________________________________________________
Phone Number: _______________________________
Fax number: _________________________________
Email Address: ________________________________
Date: ________________________________________
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U.S. Taxpayer Relief Act - Brownfields Tax Incentive
Submittal Form for a Qualified Contaminated Site
(Continued)
[Note: include the following only if applicable -- for costs incurred after
August 5, 1997 and prior to December 21, 2000].
If applicable the property must be located within one of the following areas (check which
applies):
A site announced before February 1, 1997 as being included as a Brownfields
Pilot project of the U.S. EPA. Eligible sites are located in portions of Emeryville,
Oakland, Richmond, Sacramento, San Francisco, and Stockton (reference the
enclosed list of Pilot contacts).
Federal Empowerment Zones and federal Enterprise Communities: Los Angeles
City and County Supplemental Empowerment Zone; Imperial County Enterprise
Community (USDA Rural EC); City of Watsonville/County of Santa Cruz
Enterprise Community (USDA Rural EC); South Central Los Angeles Enterprise
Community; Oakland Enhanced Enterprise Community; San Diego Enterprise
Community; and San Francisco Enterprise Community.
A census tract where 20% or more of the population is below the poverty level.
Census Tract Number:
A census tract that has a population under 2,000, has 75% or more land zoned
for industrial
or
Commercial use, and is adjacent to one or more census tracts with a poverty rate
of 20% or more.
Census Tract Number:
For properties within a U.S. EPA Brownfields pilot area, attach a map of the
designated zone with the marked location of the property.
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