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FPOM FAX NO. M, 12 2004 09:13AM P4 <br /> .,Ct1 GAEGEk _ _ <br /> [144. Doer the owner or oecvpnntpate know of�'p�dn�cd,°!W'n$lawsiuts or�ni9trative <br /> g a release or <br /> release of&.1 his 14� YEs NO � VW3 NO ]l. YES <br /> Go <br /> snbstanoc or pebolainn pmducts iovolviDg <br /> &c property by 80 owner or occupant of <br /> the propett77 <br /> 18etctily wbkb, <br /> Does tbo pmperty discharsc avy we.Stt <br /> water(not iwJuding sanctwY WNW or Olean <br /> water)oW the pwpUtY or adJsOcut IS. Y)Cs (No) t S. YL& PO M YF•S <br /> property an&ot 12!qta <br /> a nilary scwcr systern ate/ <br /> of`corm water system? <br /> 13etii7 wbicMc <br /> Did you observe evidemce or do you <br /> have my prior knowlc0t a that any <br /> h=mous MAURUCM or pmol <br /> products.,tmideen feed waste malaws,tires, <br /> wAwuotivc or industrial battc6cs,or any 1 t YES 1& YP.S 1'10 I& YES �N47 J <br /> ntha waste mai=Ws ba"been dumped <br /> above grectnd,bcaied and/or burned our►the <br /> Propeaty? <br /> ldmtlfy wbkb: <br /> I, Is there a trots ar =,capedbor,or any <br /> hydratdic agai"Mae for whieb there arc ��, <br /> any reoonu indkmft the of 17. YES NO L7, Y$S NOt YIPS U <br /> PCHa? <br /> I"t*wbich: <br /> tROjlkT MANAGER � -'^ L� —� DATE <br /> OWNER/OCCUPANT �"" DATE <br />