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Phase I / TSA Environmental Site Assessment (ESA) Questionnaire Date: <br /> Project Address: <br /> Interviewee: <br /> Page 5 of 8 <br /> (5.) Did you observe evidence or do you have prior knowledge that fill dirt has been brought onto the <br /> property that originated from a contaminated site or from an unknown origin? <br /> [:]Yes ❑No E]Unknown -if yes, describe: <br /> (6.) Are there currently, or have there been in the past, any pits, ponds or lagoons located on the <br /> property in connection with waste treatment or waste disposal? <br /> ❑Yes ❑No M Unknown -If yes, describe: <br /> (7.) Is there currently, or has there been in the past, any stained soil on the property? <br /> ❑Yes ❑No [,Unknown -If yes, describe: <br /> (8.) Are there currently, or has there been in the past, any registered or unregistered storage tanks <br /> (above or under-ground) located on the property? ❑Yes ❑ No QUnknown <br /> If yes, where are they located? Number, Size, Content <br /> (9.)Are there currently,or has there been in the past, any vent pipes,fill pipes or access ways indicating <br /> a fill pipe protruding from the ground on the property or adjacent to any structure located on the <br /> property? ❑Yes ❑ No ® Unknown -If yes, describe (include location): <br /> (10.) Are there currently, or has there been in the past, any flooring, drains or walls located within the <br /> facility that are stained by substances other than water or are emitting foul odors? <br /> [:]Yes ❑ No [Unknown -If yes, describe: <br /> Advanced Geo Environmental,Inc. <br />