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t £ <br /> Rev 2/23/2001 <br /> Page 3 of 6 <br /> r - <br /> r � lOa Are there currently any registered or unregistered Yes No Unk <br /> storage tanks (above or underground) located on the <br /> property <br /> 1 Ob Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there have been previously any registered <br /> or unregistered storage tanks (above or underground) <br /> located on the property' <br /> y <br /> Ila Are there currently any vent pipes,fill pipes, or access Yes Unk <br /> ways indicating a fill pipe protruding from the ground on <br /> Fthe property or adjacent to any structure located on the <br /> property,' <br /> 11 b Did you observe evidence or do you have any prior Yes Unk <br /> knowledge that there have 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 ONq Unk <br /> K located within the facility that are stained by substances <br /> other than water or are emitting foul odors? <br /> 12b Did you observe evidence or do you have any prior Yes Unk <br /> knowledge that there have been previously any flooring, <br /> drains, or walls located with the facility that are stained by <br /> substances other than 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 /> we]I 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 No Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that the well has been designated as <br /> contaminated by any government environmental/health <br /> agency? <br /> q 14 Does the owner or occupant of the property have any Yes � Unk <br /> 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 �Ai� Unk <br /> informed of the past existence of hazardous substances or <br /> petroleum products with respect to the property or any <br /> facility located on theproperty? <br /> /4- <br /> Initials <br />