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ASTM Transaction Screen Questionnaire <br /> for the Phase I Environmental Site Assessment (E1527-13) <br /> & Environmental Transaction Screen Processes (E1528-14) <br /> In accordance with ASTM Standard Process E1527-13, the objective of an interview/questionnaire is to <br /> obtain information indicating Recognized Environmental Conditions(RECs)in connection with the property. <br /> This questionnaire is to be completed by the current/past property owner, occupant or anyone with past <br /> knowledge concerning the property,either in written form orverbally,with questions asked by AGE or User <br /> (Client) designated parties. All questions should be answered to the best of the respondent's actual <br /> knowledge and must be answered in good faith. Explanations to any answers, especially"Yes" answers, <br /> should be made in the space following the question or on a separate sheet, noting the question number. <br /> Please be as complete as possible; if you do not know the answer to a question, please check unknown. <br /> Following the site visit, it may be necessary for AGE or the preparer to ask clarifying questions of the <br /> interviewee(s). <br /> AGE Project Name & Number: <br /> Project Address:—HZ0 L L� <br /> Interview type: ❑:Verbal Written <br /> Person Interviewed: Date:LO User/Client Information: <br /> Name: rpta 1 Name: <br /> Company: �« pu t� rr ,� y:�) )o(rompany-. <br /> Address:t.c . �x-,x it59_1 5y1)Cy-yn q5/.t(—i Address: <br /> Contact Info: 2c,`1. qc.=�i qu5i Contact Info: <br /> Relationship to property: Relationship to property: <br /> [current property owner ❑:property seller/owner <br /> F-J:former property owner ❑:property buyer <br /> FJ:property occupant :financing entity <br /> Fl:site manager R:other, list- <br /> F-1 This interview was performed by: OR F-1 This interview was performed/administered by: <br /> Name: Name: <br /> Title: Address: <br /> of Advanced GeoEnvironmental, Inc. (AGE) <br /> phone: 800-511-9300 Phone/fax: <br /> fax: 888-445-8786 Relationship to property, list: <br /> Relationship to user(client), list: <br /> The preparer represents that to the best of the preparer's knowledge the statements and facts made <br /> below are true and correct and to the best of the preparer's actual knowledge no material facts have <br /> been suppressed or misstated. <br /> (Preparer/Interviewer) <br /> Sig t Date <br /> (Interviewee, if available) <br /> Signature Date <br /> .tdti,anreciGcoEnvii�onmenial, [tic. <br /> Phone(800)511.9300•Fax(888)445-8786-www.advgeoenv.com <br />