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MATERIAL QUANTITY DATE(S) COMMENTS <br /> OBSERVED <br /> Possible asbestos Describe material: <br /> containing materials <br /> (e.g, pipe, building, etc.) <br /> Fill dirt originating from Source: <br /> an unknown or <br /> contaminated site? <br /> Pits, ponds, or lagoons Location: <br /> associated with waste <br /> treatment or waste <br /> disposal? <br /> Stained soil or odiferous Location : <br /> soil? (e. g. oily black) <br /> Sumps or dry wells" Size : <br /> Contents <br /> Condition : <br /> Vent pipes, fill pipes, Location : <br /> access ways to a fill pipe <br /> protruding from the <br /> ground or adjacent to a <br /> structure onsite? <br /> Heating and cooling Source: <br /> systems (include fuel <br /> source) <br /> Flooring, drains , walls Location : <br /> that are stained or <br /> emitting a foul odor (do <br /> NOT include water <br /> damage)? <br /> 'Please provide records if available. N <br /> 8. Is the property served by a private well or non-public water system? If so , please <br /> answer the following : <br /> a . Was the well used for domestic (D) , agricultural irrigation ( 1 ) , or monitoring ( M) <br /> purposes? Are the wells currently operational and if not, when were they last <br /> used? When was the well drilled ? How deep is the well? What is the <br /> approximate discharge rate? <br /> Well Type Operating? Last Used Date Drilled Depth Discharge Location <br /> No. Rate <br /> 1 - <br /> 2- <br /> 4 <br />