Information collected from this survey will be used to determine the potential risk to human health and the environment resulting from historical operation of former/abandoned agricultural chemical facilities. Participation in this survey is voluntary. You are not legally required to provide the MDA with the requested information and may refuse to do so. However, failure to submit the survey will limit the MDA’s ability to assess the potential risk related to the site in question. Survey responses will be considered public data unless information obtained in a survey results in an active civil investigation; in which case, the information submitted in the survey would be classified as “not public” data. “Not public” data is available only upon court order or upon request of a legislative auditor to review the data. In addition, data may be made public if the MDA determines that there is a substantive threat to human health and safety or to the environment, or if otherwise required by law.

If you have any questions regarding this survey please contact Paul Haiker at 651-201-6199.

Your Name
General Information
Are you the current owner of the property listed above?
Have other entities operated an Agricultural Chemical facility at the site?
Onsite Storage
Was liquid fertilizer stored at the site?
Was dry fertilizer stored at the site?
Were mini-bulk or bulk pesticides stored at the site?
Were small package pesticides stored at the site?
Were vehicles or equipment used to transfer or apply pesticides or fertilizers stored at the site?
Mixing and Loading
Did mixing and loading of pesticides occur at the site?
Did mixing and loading of fertilizers occur at the site?
Is a load pad present at the site?
Was there a load pad for mixing/loading at the site?
Buildings and Structures
Are there previously used Agricultural Chemical storage structures present at the site?
Please describe the floor(s)
For Agricultural Chemical storage facilities no longer present on the site, please describe floor(s) if known
Water
Is/was there a public water source on site?
Is/was there a private well on site?
Incidents
Are you aware of past pesticide or fertilizer spills or releases having occurred on the site?
Was the spill(s) or release(s) reported to the Minnesota Duty Officer or MDA?
Was the spill(s) or release(s) cleaned up?
Are you aware of, or do you suspect agricultural chemical contamination on the site currently?