The City of Calgary | P.O. Box 2100 Stn. M | Calgary, AB, Canada T2P 2M5 | calgary.ca
Are you aware of any regulatory actions, past or current, which have been
applied to this site?
Examples include (but are not limited to):
- Environmental Protection Orders
- Reclamation Orders or Certificates
- Control / Stop Orders, fines, tickets or prosecutions
- Violations of environmental statutes, regulations and bylaws
- Administrative penalties and warning letters
If yes, please describe and provide copies of relevant documents:
Have any permits been issued or are you currently operating under a license
or approval issued by federal or provincial authorities or the Calgary Fire
Department for activities which may impact the property?
(e.g. certificates of approval, storage tank regulations, plant operating permits)
If yes, please describe:
Has there been contact with Alberta Environment or Calgary Regional Health
Authority regarding possible contamination on the site?
If yes, please provided a brief description:
NOTE: This form is to be signed by the titled owner(s) of the property or their authorized agents or consultants.
I, the owner, authorized agent, authorized consultant, state that, to the best of my
knowledge, the information provided in this statement is accurate, complete and is based on diligent
inquiry and thorough inspection and review of all the documents and other information reasonably
available pertaining to the subject property. I am not aware of any other information that may indicate
that the subject property is potentially contaminated.
FOIP DISCLAIMER: The personal information on this form is being collected
under the authority of The Freedom of Information and Protection of Privacy
(FOIP) Act, Section 33(c). It will be used to provide operating programs, account
services and to process payments received for said services. It may also be used
to conduct ongoing evaluations of services received from Planning, Development
& Assessment. Please send inquiries by mail to the FOIP Program Administrator,
Planning, Development & Assessment, PO Box 2100, Station M, Calgary, AB T2P
2M5 or contact us by phone at 311.
Applicant Name (Please Print)
Company Name (Please Print)
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