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all- <br /> 1 J _ f-3 Rev 2/23/2001 <br /> Page I of G <br /> io <br /> TRANSACTION SCREEN QUESTIONNAIRE <br /> SITE <br /> This questionnaire has 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 jnfojmatjon regarding the presence or <br /> likely presence of any hazardous substances or petroleum products on the property that may <br /> f present a material risk of harm to public Health or to the envnonment Information provided by <br /> this questionnaire will be used to identify recognized environmental conditions existing on the <br /> Site that may or may not require additional research The questionnaire is provided on a <br /> voluntary bans by the respondent as part of a customary practice for conducting an <br /> 1 Environmental Site Assessment on a specific parcel of real estate Please respond to the best of <br /> your ability To provide further information, please descjjbe reason for any affirmative answers <br /> on a separate sheet of paper <br /> RESPONDENT(CHECK ONE) <br /> Owner El Occupant TP�rep�erdttrutg Site visit) <br /> Question Answer <br /> la is this Site used for an industrial use? Yes No Unk <br /> r<� t <br /> i 1 b Is any adjoining property used for an industrial use? Yes No Unk <br /> • 2a Did you observe evidence or do you have any prior Yes o Unk <br /> knowledge that the property has been used for an industrial <br /> use in the past? <br /> 2b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that any adjoiningproperty has been used for an <br /> industrial use in the past? <br /> 3a Is the property used as a gasoline station, motor repair Yes No Unk <br /> facility, dry cleaners, photo developing laboratory, f _ �J <br /> junkyard of landfill, or as a waste treatment, storage, <br /> disposal, processing, or recycling facility(if applicable, v�P� <br /> identify which)? <br /> r 3b Is any adjoining property 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 �,� f A ,4� Q�� <br /> ,l applicable, jdentify which)? r <br /> 4a Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that the property has been used as a gasoline -r <br /> station, motor repair facility,dry cleaners, photo developing ]y7 0t�f <br /> laboratory,junkyard of landfill, or as a waste treatment, <br /> l` storage, disposal, processing, or recycling facility (if <br /> . applicable, identify which)? <br /> 1 <br /> 1ntt�al � ��✓�� <br /> { <br />