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6- TRrtrJSACTION SCREEN QUESTIONNATTi E
<br /> Page 1 of 3
<br /> Description of Site/Address:
<br /> Question: Circle Answer: Explain
<br /> "Yes" Answers below
<br /> 1. Is the property or any adjoining property used for industial use? YES NO UNK
<br /> 2. To the best of your knowledge, has the property or any adjoining YESNO UNK
<br /> property been used for an industrial use in the past?
<br /> 3. Is the property or any adjoining property used as a gasoline station, YES N� UNK
<br /> motor repair facility, commercial printing facility, dry cleaners, photo
<br /> ` developing laboratory, junkyard or landfill, or as a waste treatment,
<br /> storage ,disposal, processing, or recycling facility?
<br /> `, 4. To the best of your knowledge, has the property or any adjoining YES NO UNK
<br /> property been used as a gasoline station, motor repair facility,
<br /> commercial printing facility, dry cleaners, photo developing laboratory,
<br /> junkyard or landfill, or as a waste treatment, storage, disposal,
<br /> �. processing, or recyling facility?
<br /> 5. Are there currently, or to the best of your knowledge have there YESNO UNK
<br /> been previously, any damaged or discarded automotive or industrial �-
<br /> ` batteries, or pesticides, paints, or other chemicals in individual
<br /> containers of greater than 5 gal 090 in volume or 50 gal (190 L) in
<br /> the aggregate, stored on or used at the property or at the facility?
<br /> 6. Are there currently, or to the best of your knowledge have there YES NO UNK
<br /> been previously ,any industrial drums (typcially 55 gal (208 U) or sacks
<br /> of chemicals located on the property or at the facility?
<br /> 7. Has fill dirt been brought onto the property that originated from a YES NO UNK
<br /> contaminated site or that is of an unknown origin?
<br /> 8. Are there currently, or to the best of your knowledge have there YES NO UNK
<br /> been previously, any pits, ponds, or lagoons located on the property in
<br /> connection with waste treatment or waste disposal?
<br /> 9. Is there currently, or to the best of your knowledge has there been YES NO UNK
<br /> previously, any stained soil on the property?
<br /> 10. Are there currently, or to the best of your knowledge have there YESNO UNK ,
<br /> been previously, any registered or unregistered storage tanks (above or
<br /> underground) located on the property?
<br /> 11. Are there currently, or to the best of your knowledge have there YES NO UNK
<br /> been previously, any vent pipes, fill pipes, or access ways indicating a
<br /> fill pipe protruding from the ground on the property or adjacent to any
<br /> 6- structure located on the property?
<br /> 12. Are there currently, or to the best of your knowledge have there YES NO UNK
<br /> been previously, any flooring, drains, or walls located within the facility
<br /> that are stained by substances other than water or are emitting foul
<br /> odors?
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