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TRANSACTION SCREEN QUESTIONNAIRE <br /> Page 3 of 5 <br /> Owner Occupant Observed During Site <br /> Question: (Dave Taylor) (Dave Taylor) Visit <br /> (Explain"Yes' answers below} YES NO UNK YES NO UNK YES NO UNK <br /> other waste materials been dumped above grade, buried <br /> andlor burned on the property? <br /> 20. Is there a transformer, capacitor, or any hydraulic ! 1 <br /> equipment for which there are any record indicating the <br /> presence of PCBs? <br /> Government Records/Historical Sources Inquiry <br /> 21. Do any of the following Federal government record systems list the property or any property within the <br /> circumference of the area noted below: <br /> National Priorities List-within 1.0 mile (1.6 Km)? NO <br /> CERCLIS List-within 0.5 mile (0.8 Km)? NO <br /> i <br /> RCRA TSD Facilities-within 1.0 mile (1.6 Km)? NO <br /> 22. Do any of the following state record systems list the property or any property within the circumference of the area <br /> noted below: <br /> i List maintained by state environmental agency of <br /> Hazardous waste sites identified for investigation <br /> or remediation that is the state agency equivalent <br /> to NPL— within approximately 1.0 mile 0.6 Km)? NO <br /> List maintained by state environmental agency <br />' of sites identified for investigation or remediation <br /> that is the state equivalent to CERCUS — <br /> within 0.5 mole (0.8 Km)? NO <br /> Leaking Underground Storage Tank (LUST) <br /> List— within 0.5 mile (.08 Km)? NO <br /> Solid Waste/landfill Facilities — within <br /> 0.5 mile (0.8 Km)? NO <br /> 23. Based upon a review of fire insurance maps or consultation with the local fire department serving the property, all <br /> as specified in the guide, are any buildings or other improvements on the property or on an adjoining property <br /> identified as having been used for an industrial use or uses likely to lead to contamination of the property? <br /> NO <br /> Explaination to "YES" answers: <br /> Question # Answer <br /> 3 Septic system in place at residence in southeast portion of property. <br /> 4 Septic system presumably in place at residence since constructed in late 1930slearly 1940s. <br /> 5 Pesticides/insecticides used regularly in ag operations; however none stored on site or observed during site <br /> inspection. <br /> 20 Mr.Taylor indicated a transformer near Well No. 1/residence. The transformer is actually a pole mounted unit <br /> on the east side of Tully Road, not within propertX boundaries. <br /> G:\Data\GROUNOZE\PHASE1\siagandtqs.doc <br /> I <br /> I <br />