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Ft 1 <br /> { ENVIRONMENTAL SITE ASSESSMENT QUESTIONNAIRE _ _ _ _ Page 3 <br /> i23.Does the owner or occupant of the property have any knowledge of YesNo Unknown <br /> environmental liens or governmental notification relating to past or <br /> recurrent violations of environmental laws with respect to the property or <br /> any facility located on the property? <br /> FJ <br /> 24. Has the owner or occupnt of the property been informed of the past or Yes No Unknown <br /> current existence of hazardous substances or petroleum products or <br /> environmental violations with respect to the property or any facility located <br /> on the property? <br /> �l 25.Does the owner or occupant of the property have any knowledge of any Yes Unknown <br /> t-F environmental site assessment of the property or facility that indicated the <br /> presence of hazardous substances or petroleuni products on,or <br /> contamination of,the property or recommended further assessment of the <br /> property? <br /> :76.Does the owner or occupant of the property know of any past, Yes No Unknown <br /> threatened,or pending lawsuits or administrative proceedings concerning a <br /> zrelease or threatened release of any hazardous substance or petroleum <br /> products involving the property by any owner or occupant of the property? <br /> 27.Is there an active or abandoned on-site septic system in place? Yes No <br /> �ow <br /> 28.Does the'property discharge waste water on or adjacent to the property Yes Unknown <br /> F other than storm water into a sanitary sewer system? LG <br /> f <br /> 29.To the best of your knowledge,have any hazardous substances or Yes No Unknown <br /> petroleum products,unidentified waste materials,tires,automotive or <br /> industrial batteries or any other waste materials been dumped above grade, <br /> buried and/or burned on the property? <br /> 30.Is there a transformer,capacitor,or any hydraulic equipment for which Yes No U <br /> there are any records indicating the presence of PCBs? <br /> FAi <br /> W6 O's <br /> PPreparer Name Company <br /> t Title Date <br /> 1 <br /> r <br /> �I <br /> w <br /> } <br /> 1 <br /> 01 <br /> j <br /> i <br />