Laserfiche WebLink
1 <br /> Transaction Screen Questionnaire <br /> ' Site name S TD G i< l D AJ CA L I FO 2a11 A <br /> Site address. _ P?O15- (;E/V E2,A L-L-y LOCA TES <br /> Description of site 'c-%) I rN TN >r /,3 L-o CJC G 0 1�1 N D EO Q Y <br /> A.AA✓LKEi ZSiAn1,rC-AuS LVAS4,W670An <br /> ' ANA AkiC�rEAN CAC'7-S <br /> Questions Owner Occupants Observed During <br /> ' Site Visit <br /> 1. Is the property or any adjoining Yes No Unk(a) Yes No Unk Yes 9 Unk <br /> property used for an industrial use? <br /> ' 2. To the best if your knowledge, Yes No Unk Yes No Unk Yes (!.0) Unk <br /> has the property or any <br /> ' adjoining property been used <br /> for an industrial use in the past? <br /> 3. is the property or any adjoining Yes No Unk Yes No UnkYes No Unk <br /> ' property used as a gasoline station, <br /> motor repair facility, commercial <br /> printing facility, dry cleaners, photo <br /> developing laboratory, junkyard or <br /> ' landfill, or a waste treatment, <br /> storage, disposal, processing, or <br /> recycling facility? <br /> 4 To the best of your knowledge, Yes No Unk Yes No Unk es No Unk <br /> has the property or any adjoining <br /> property been used as a gasoline <br /> ' station, motor repair facility, <br /> commercial printing facility, dry <br /> cleaners, photo developing laboratory, <br /> junkyard or landfill, or a waste <br /> ' treatment, storage, disposal, <br /> processing, or recycling facility? <br /> 5. Are there currently, or to the best Yes No Unk Yes No Unk QL5 No Unk <br /> of your knowledge have there been <br /> previously, any damaged or discarded <br /> automotive or industrial batteries, <br /> or pesticides, paints, or other chemicals <br /> in individual containers of greater than <br /> 5 gallons in volume or 50 gallons in the <br /> aggregate, stored on or used at the <br /> ' property or at the facility? <br /> $. Are there currently, or to the best Yes No Unk Yes No Unk Yes No Unk <br /> of your knowledge have there been <br /> ' previously, any industrial drums (typically <br /> 55-gallon) or sacks of chemicals located <br /> on the property or at the facility? <br /> 7 Has fill dirt been brought onto the property Yes No Unk Yes No Unk Yes �J Unk <br /> that originated from a contaminated site or <br /> that is of an unknown origin? <br /> 8. Are there currently, or to the best Yes No Unk Yes No Unk Yes ON Unk <br /> (GUIDeASTM TSO) page 1 of 5 <br />