Contaminated Sites Disclosure Statement

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www.islandstrust.bc.ca 
 
 
Galiano, Mayne, North Pender,  
Saturna, South Pender Islands 
 
Southern Office 
200 - 1627 Fort Street 
Victoria, BC  V8R 1H8 
Ph: (250) 405-5151 
southinfo@islandstrust.bc.ca 
Ballenas-Winchelsea, Salt 
Spring Islands 
 
Salt Spring Office 
4 - 121 McPhillips Avenue 
Salt Spring Island, BC  V8K 2T6 
Ph: (250) 537-9144 
ssiinfo@islandstrust.bc.ca 
Denman, Gabriola, Gambier, 
Hornby, Lasqueti, Thetis Islands 
 
Northern Office 
700 North Road 
Gabriola Island, BC  V0R 1X3 
Ph: (250) 247-2063 
northinfo@islandstrust.bc.ca 
 
NOTE: This information is intended to provide guidance and should not be interpreted as a right to a development approval if the steps indicated are followed. 
Please consult the Local Government Act and its regulations, as well as the other Islands Trust applicable bylaws for the definitive requirements and 
procedures. For any further information, please contact Islands Trust. Islands Trust staff cannot offer legal advice on the interpretation of statutes or bylaws, 
or answer for other agencies that may be affected by your inquiry. Persons requiring such advice should seek professional legal counsel and/or consult with 
other agencies where applicable. 
Site Disclosure Statement 
 
This notice is for applicants for Development Permits, Soil Removal Permits, Siting and Use Permits, and Zoning 
Bylaw Amendments. Under the Environmental Management Act, you are required to complete and submit to the 
Islands Trust a Schedule 1: Site Disclosure Statement if you know, or reasonably should know, that the land under 
application is or was used for industrial or commercial purposes or activity. Information on identifying and 
disclosing sites that may be contaminated are found on the Province’s Site Remediation website.  
 
To determine if you need to complete a Schedule 1: Site Disclosure Statement, please refer to the Province’s 
Schedule 2 Specified Industrial or Commercial Uses of the Contaminated Sites Regulation for a list activities. 
 
Failure to satisfactorily complete this form or the Schedule 1: Site Disclosure Statement, if required, may result in 
delays or an inability to process your permit application.  
 
If you have any questions or require further information concerning the Site Disclosure Statement or 
Contaminated Sites Regulation, please contact the Province of British Columbia’s land remediation team at 
site@gov.bc.ca.  
  
Applicant Declaration 
 
Having reviewed the current version of Schedule 2 of the Contaminated Sites Regulation under the Environmental 
Management Act, I declare that, based on my personal knowledge, available records, and reasonable searches 
and inquiries, the land under application: 
Site Address: _________________________________________________________________ PID: ____________________ 
☐ has never been used for industrial or commercial purposes listed in Schedule 2. 
 
☐  is currently used or has been used for industrial or commercial purposes, the detai

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