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Phase I /TSA Environmental Site Assessment (ESA) Questionnaire Date: <br /> Project Address: <br /> Interviewee: <br /> Page 3 of 8 <br /> ADDITIONAL HAZARDS <br /> Lead-based Paint (LBP): Are you aware of the presence of LBP-coated surfaces on the property <br /> structure(s)? ❑ Yes ❑ No Unknown <br /> If yes, describe: <br /> Is there any evidence on the subject property of illegal or dangerous on-site application, handling or <br /> storage of maintenance chemicals such as pesticides, rodenticides,fertilizers,cleaners, paint solvents, <br /> swimming pool cleaners, etc? ❑Yes ❑ No Unknown <br /> If yes, describe: <br /> Have there ever been any dry wells, sumps, separators (or clarifiers or grease traps) or in-ground <br /> hydraulic lifts on the property? ❑Yes ❑ No 'Unknown <br /> If yes, describe (include where, what use and size, if known): <br /> SUBJECT PROPERTY UTILITY INFORMATION <br /> Is water currently provided by: Mpublic water system ❑well ❑private company <br /> Vk <br /> List name of utility provider and/or location of well, connection date: ❑none or list- <br /> Electrical utility provider and estimated connection date: ❑none or list- <br /> 1P G <br /> ist-1PG Ai <br /> Natural gas utility provider and estimated connection date: ❑none or list- <br /> Does the property discharge waste water to a: bmunicipal sewer sanitary system; [_]on-site <br /> sewage treatment system; ❑on-site septic system; or ❑there is no sewer utility/septic on-site. <br /> If the property is served by a septic system or systems, please list the location of the system (is <br /> a permit available?): <br /> Advanced GeoEnvironmental,Inc. <br />