Laserfiche WebLink
Ell <br /> Rev 2/23/2001 <br /> d.3 i'kaL. I at G <br /> '. TRANSACTION SCREEN QUESTIONNAIRE <br /> i 1 SITE <br /> This questionnaire leas been prepared by Condor Earth Technologies, Inc (Preparer) by request <br /> from CLIENT (User) in order to obtain information regarding the proposed SITE (Site) The <br /> objective of this questionnaire is to provide the User with information regarding the presence or <br /> likely presence of any hazardous substances or petroleum products on the property that may <br /> present a material risk of harm to public health or to the environment Inforination provided by <br /> this questionnaire will be used to identify recognized environmental conditions existing on the <br /> Site that may or may not i equire additional research The questionnaire is provided on a <br /> voluntary basis by the respondent as part of a customary practice for conducting an <br /> Environmental Site Assessment on a specific parcel of real estate Please respond to the best of <br /> your ability To provide further information, please describe reason for any affirmative answers <br /> on a separate sheet of paper <br /> RESPONDENT(CHECK ONE) <br /> Owner <br /> Ell Occupant ❑ Preparer(during Site visit) <br /> Question Answer <br /> I a Is this Site used for an industrial use? Yes No Unk <br /> k�-e51 <br /> 1 <br /> lb is any adjoining property used for an industrial. use? Yes to Unk <br /> 2a. Did you observe evidence or do you have any prior Yes 0o Unk <br /> knowledge that the property has been used for an industrial <br /> use m the past? <br /> 2b Did you observe evidence or do you have any prior Yes Unk <br /> knowledge that any adjoining property has been used for an <br /> industrial use in the past? <br /> n; 3a Is the property used as a gasoline station, motor repair Yes } Unk <br /> facility, dry cleaners, photo developing laboratory, �- <br /> junkyard of landfill, or as a waste treatment, storage, <br /> 4 <br /> t disposal, processing, or recycling facility(if applicable, <br /> h identify which)? <br /> 3b Is any adjotningproperry used as a gasoline station, Yes (::No] Unk <br /> motor repair facility, dry cleaners, photo developing <br /> laboratory,junkyard of landfill, or as a waste treatment, <br /> { storage, disposal, processing, or recycling facility(if <br /> F` applicable, identify which)? <br /> .�i <br /> 4a Did you observe evidence or do you have any prior Yes �I UUnk <br /> knowledge that the property has been used as a gasoline <br /> station, motor repair facility, dry cleaners, photo developing <br /> laboratory,j unkyard of landfill, or as a waste treatment, <br /> storage, disposal, processing, or recycling facility(if <br /> ` applicable, identify which)? <br /> Initials <br />