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l S <br /> � Rev 2/23/2001 <br /> � � <br /> � Page 3 of 6 <br /> IOat there h re c urrently any registered or unregistered Yes � Unk <br /> 1 storage tanks (above or underground) located on the <br /> property" <br /> I Ob Did you observe evidence or do you have any prior Yes N Unk <br /> knowledge that there has been previously, any registered or <br /> unregistered storage tanks(above or underground) located <br /> g s on the property,' <br /> Ila Are there currently any vent pipes,fill pipes, or access Yes No Unk <br /> ways indicating a fill pipe protruding from the ground on <br /> 1 the property or adjacent to any structure located on the <br /> property," <br /> I 1 b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there has been previously, any vent pipes, <br /> fill pipes, or access ways indicating a fill pipe protruding <br /> from the ground on the property or adjacent to any structure <br /> located on the property? <br /> 12a Are there currently any flooring, drains, or walls Yes Unit <br /> located within the facility that are stained by substances <br /> other that water or are emitting foul odors? <br /> j 12b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there has been previously, any flooring, <br /> lie drams, or walls located with the facility that are starred by <br /> g substances other that water or are emitting foul odors` <br /> 13a If the property is served by a private well, or non- Yes No Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that contaminants have been identified in the <br /> well or system that exceed guidelines applicable to the <br /> water system? <br /> 13b If the property is served by a private well, or non- Yes Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that the well has been designated as <br /> i contaminated by any government environmental/health <br /> agency? <br /> 14 Does the owner or occupant of the property have any Yes No Unk <br /> k knowledge of environmental liens or governmental <br /> notification relating to past or recurrent violations of <br /> environmental laws with respect to the property or any <br /> facility located on the property,' <br /> 15a Has the owner or occupant of the property been Yes CN3o Unk <br /> informed of the past existence of hazardous substances or <br /> petroleum products with respect to the property or any <br /> r <br /> facility located on the propertyP <br /> ' > <br /> initials <br />