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FROM FAX NO. Mai- 12 2004 08:12AN P3 <br /> JOEL CFt6t}+ <br /> If the prnpcnY is scrvod by a private — —� <br /> .veli or Avn-public water*vtmn,is tbert <br /> cvidcam or do you have am prior <br /> j,Wledge that gQM&UU M=have been <br /> idcuttfiod in the well or"em*&I ttteeed F -1 <br /> guidelines applicable to the waist sYslCan- litY NO YES ?IO 1A YES (10 <br /> Ideotdy wbith: <br /> Ig& If the pmpctY is served by a Private <br /> well or nan-public water system,is there 1q. YES NO 1!& M NO If& YES <br /> midenee m do you bave MV tAm <br /> kwwlcdsc that the well bas boon dmgnwod <br /> as sommigod by crony govanaert <br /> covirvanxnUdAlcalth agemy? <br /> Idsotw Wh": <br /> IL Do"the OvAWr or mcuperrt of the <br /> property have a0y l000wledv of <br /> enviroumer"liens or Wvernrnentni <br /> notif3cation relating to Pant oa•M=fm" Yl~8 ONO <br /> YES NoYE6 <br /> vialatiom of envir+oameatal Iaws with <br /> rr�poc-t to dre pppwy or any fwa* <br /> located on the propOIY? <br /> 16=tlly Wbkb: <br /> a Has the owner or ooaopant of the � <br /> propc M been informed Of the cunwd <br /> existence of haaardmm mbs>ancex or <br /> pe 9leum prodncrts WM respect to the <br /> property or soy facility located on lite Iz YES rro 12- ries NO t2. V" G <br /> prop my? <br /> Idaiwtify wbirb: <br /> a& Was the owner M Apaumit of the L!k& YESNO M. YES NO �4__ VXS <br /> p mperty been inforund of d)C�OCLAMCC <br /> of the above merdioml Wah the mapect W <br /> the peoperty or airy faetltty located an the <br /> Ideon w�l+": <br /> Docs the awner or amupom of the <br /> rrgwny have any knowledge of any <br /> denim site of seatlment of the <br /> pr j%", y or facility dol indicated rite <br /> pr wnce of bAur4otm mWartoes or YES (NO 13. YES 110 13. YES <br /> petrel�rm rndrp:t%on,nr mnmminatinn of. <br /> the pmr wfy cx rr.CAmmtnacd flusher <br /> agsesantent of dw propetfw <br /> Idm try wbieb: <br />