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Required fields are marked with asterisks (
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Part 1: Facility Information
Are you the building owner or a tenant?
Building Owner
Tenant
Is this a multi-tenant building?
Yes
No
Do not know
Legal Company Name
Facility Address
City
State
Michigan
Zip Code
Number of Employees
Is company mailing address different from facility address?
Yes
No
Company Telephone Number
Name of Company Representative
Title of Company Representative
Company Representative Phone Number
Company Representative Email Address
List all Business Activities Performed at this Facility
i.e. what does your company do? Be as specific and detailed as possible. <br><br>For example, if your facility manufactures electrical components, do not just write “manufacturing”, include the details of what your facilities does.
NAICS Code 1 for this Facility
NAICS Code 2 for this Facility
For help with NAICS Codes, visit https://www.census.gov/naics/ select the FAQ tab at the top, and select FAQ #9.
NAICS Code 3 for this Facility
For help with NAICS Codes, visit https://www.census.gov/naics/ select the FAQ tab at the top, and select FAQ #9.
NAICS Code 4 for this Facility
For help with NAICS Codes, visit https://www.census.gov/naics/ select the FAQ tab at the top, and select FAQ #9.
Does your business have a Federally regulated industrial process?
In the Code of Federal Regulations, Title 40 (40 CFR), categories have been established to regulate a number of industrial dischargers.
Yes
No
Unknown
Is there any known contamination at this address?
Yes
No
Unknown
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