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NUV-JU—ZO04 11:!:)1 C;UNDOR EAk FH TECH 209 532 0773 P.05 <br /> Rev.6/26//2001 <br /> Page 1 of 5 <br /> TRANSACTION SCREEN QUESTIONNAIRE <br /> . PHASE I ENVIRONMENTAL SITE ASSESSMENT <br /> This questionnaire has been prepared by Condor Earth Technologies, Inc. (Preparer) by request <br /> from the Client. (User) in order to obtain information regarding the site. The objective of this <br /> questionnaire is to provide the User with information regarding the presence or likely presence of <br /> any hazardous substances or petroleum products on the property that may present a material risk <br /> of harm to public health or to the environment. Information provided by this questionnaire will <br /> be used to identify recognized environmental conditions existing on the Site that may or may not <br /> require additional research. The questionnaire is provided on a voluntary basis by the respondent <br /> as part of a customary practice for conducting an Environmental Site Assessment on a specific <br /> parcel of seal estate. Please respond to the best of your ability. To provide further information, <br /> please describe reason for any affirmative answers on a separate sheet of paper. <br /> I <br /> RESPONDENT(CHECK OM) <br /> Owner [` Occupant ❑ Tpreparer(during Site visit} Q <br /> Question Answer <br /> la. Is this Site used for an industrial use? Yes oNo Unk <br /> lb. Is any adjoining property used for an industrial use? Yes Unk <br /> } 2a. Did you obseave evidence or do you have any prior Yes N Unk <br /> L knowledge that the property has been used for an industrial <br /> use in the past? <br /> 2b. Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that any adjoining property has been used for an <br /> industrial use in the past? <br /> 3a. Is the property used as a gasoline station,motor repair Yes oNo Unk <br /> facility, dry cleaners,photo developing laboratory, <br /> junkyard or landfill, or as a waste treatment,storage, <br /> disposal;processing, or recycling facility(if applicable, <br /> identify which)? <br /> 3b. Is any adjoining property used as a gasoline station, Yes No Unk <br /> motor repair facility, dry cleaners,photo developing <br /> laboratory,junkyard or landfill, or as a waste treatment, <br /> storage, disposal,processing, or recycling facility(if <br /> applicable,identify which)? <br /> 4a. Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that the property has been used as a gasoline <br /> station,motor repair facility, dry cleaners,photo developing <br /> laboratory,junkyard or landfill,or as a waste treatment, <br /> storage, disposal,processing, or recycling facility(if <br /> applicable,identify which)? <br /> Initials, v <br /> RECEIVED TIME NOV. 30. 11 . 51AM <br />