Information request form

Prior to submitting this form, please verify that the information you are requesting is not already available on the Minnesota Pollution Control Agency science and data page.

Requester information

The MPCA will provide you with contact information so that you will be able to check on the status of your request. However, if the agency file manager handling the request has questions about it but is unable to contact you for clarification, this may result in a delay in processing the request.

Information request form

Requester name

Date:

Requester email address

Phone number

Organization name

Organization or requester billing address

Site/Facility information

Site/Facility name

Previous site/facility name

Site address/location

City

Zip Code

MPCA Preferred ID or Site ID from What’s in my neighborhood (WIMN e.g., leak #, permit #, haz waste #)

Agency Interest ID number

Current public notice item:

Yes

Area of interest (check one item per request form):

Area of interest

Information requested - Describe the information that you need (be as specific as you can):

Yes - I acknowledge and agree by submitting this information request form that I may be subject to costs as per the current costs schedule.

I also agree to pay all costs within 30 days of the invoice date.