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fi <br /> r <br /> Rev 2P-3/2001 <br /> e <br /> Page 3of6 <br /> 1 Oa Are there currently any registered or unregistered Yes �a.� Unk <br /> J 0 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 has been previously, any registered or <br /> unregistered storage tanks (above or underground) located <br /> on the property <br /> Ila Are there currently any vent pipes,fill pipes, or access Yes CNa) Unk <br /> ways indicating a fill pipe protruding from the ground on <br /> 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, f <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 /> r <br /> 12a Are there currently any flooring, drains, or walls Yes [No r' Unk <br /> located within the facility that are stained by substances �. <br /> other that water or are emitting foul odors? <br /> 12b Did you observe evidence or do you have any prior Yes o Unk <br /> 1 knowledge that there has been previously, any flooring, <br /> drains, or walls located with the facility that are stained by <br /> r a 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 y�r� <br /> knowledge that contaminants have been identified in the r <br /> well or system that exceed guidelines applicable to the ���r C► /4*r- fs fr,�j <br /> water system? ( _ <br /> 4 ` 136 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 environmentaVhealth 51 <br /> agency? fel'oz. <br /> 14 Does the owner or occupant of the property have any Yes o~ ' 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 property2 <br /> f <br /> l Sa Has the owner or occupant of the property been Yes % No 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 the property2 <br /> � j <br /> Inmais <br /> I <br />