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STEP ONE – (This form must be submitted and redevelopment project approved by Salem/Peabody RLF Program before submitting any other forms) Brownfield Redevelopment Project Preliminary Application All brownfield redevelopment projects submitted to the Salem/Peabody RLF Program will be evaluated to determine if they are within the scope of the Programs EPA RLF work plan. Selected projects that meet the preliminary criteria will be advanced to the next step‐ Eligilbilty Pre‐ Applicationt. Contact Information Applicant Name: Address: City: State: Zip Code: Contact Name Phone: Email: Name of Project RLF Amount Requested (can be approximate): Site Location, Description and History Tax‐ID#: Address: Major cross roads: MassDEP Release Tracking Number(s) Applicable to the Site: Current use and activity: Operational history: Environmental Concerns Salem/Peabody Brownfield Revolving Loan Fund Program ---PAGE BREAK--- Site Ownership Site owner name: Site owner address: How did site become contaminated: Who was responsible for the contamination: If owned by applicant, means of taking ownership and date of acquisition: If not owned by applicant, relationship to owner and role of owner in the work: Status of Environmental Due Diligence (All Appropriate Inquiry): Any on‐going or anticipated environmental enforcement actions: Site Redevelopment Existing Zoning: Detailed Potential Development for Site: Describe Development Strategy: Has a Developer Been Selected Yes No If Yes who, if not when: ---PAGE BREAK--- Financial Commitment Are there any other financial incentives, such as grants, loans, tax credits or tax increment financing being considered for this project? Jobs created: Full Time‐ Part Time‐ Retained‐ Construction‐ Submit Completed Form to: City of Salem Department of Planning & Community Development 120 Washington Street 3rd Floor Salem, MA 01970 Attention: Tom Devine, Senior Planner [EMAIL REDACTED] or City of Peabody Community Development & Planning Department 24 Lowell Street Peabody, MA 01960 Attention: Brendan Callahan, Assistant Director of Planning brendan.callahan@peabody‐ma.gov