General Information Sheet Draft for comment

2006 Brownfields Assessment Grant Proposal Former Gas Station Assessment Tacoma Pierce County Health Department Draft1. Applicant Information: Tacoma-Pierce County Health Department, 3629 South D Street, Tacoma, WA 98418-6813 2. Funding Requested a. Grant Type: Assessment b. Amount: $200,000 c. Contamination: Petroleum d. Assessment Scope: Community-wide 3. Location City: City of Honorable Bill Baarsma, Mayor Office of the Mayor Tacoma City of Tacoma 747 Market Street, Suite 1220, Tacoma WA 98402-3766 (253) 594-7848 Fax 591-5123 bbaarsma@cityoftacoma.org County: Pierce County Honorable John Ladenburg, Pierce County Executive Office of the Pierce County Executive 930 Tacoma Avenue South, Room 737, Tacoma WA 98405 253-798-7477 Fax (253) 798-6628 pcexecutive@co.pierce.wa.us State: Washington Honorable Christine Gregoire, Govenor Office of the Governor State PO Box 40002, Olympia, WA 98504-0002 (360) 902-4111 Fax (360) 753-4110 http://www.governor.wa.gov/contact/govemail.htm 4. Contacts Head of Federico Cruz-Uribe, M.D., MPH, Director of Health Organization: Tacoma-Pierce County Health Department 3629 South D Street, Tacoma, WA 98418-6813 (253) 798-2899 Fax (253) 798-7627 fcruz@tpchd.org Gregory M. Tanbara, Brownfields Coordinator Project Director: Tacoma-Pierce County Health Department 3629 South D Street, MS-323, Tacoma, WA 98418-6813 (253) 798-4784 Fax (253) 798-6294 gtanbara@tpchd.org 5. Date Submitted: December 14, ...