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4 Rev, 7/23/2001 <br /> Page 3 of 5 <br /> I Oa. Are there currentlyan . <br /> Y registered dor unregistered Yes No iJnk <br /> storage tanks (above or underground) located on the --- <br /> property? <br /> I Ob. Did you observe evidence or do you have any prior No s 1' No Unk . <br /> knowledge that there have been previously any registered <br /> or unregistered storage tanks (above or underground) <br /> located on the property? <br /> I I a. Are there currently any vent pipes, fill pipes, or access Yes No <br /> ways indicating a fill pipe protruding from the ground on nk <br /> the property or adjacent to any structure located on the <br /> property? <br /> I l b. Did you observe evidence or do you have any prior Yes fNDo Unk <br /> knowledge that there have been previously any vent pipes, <br /> fill pipes,. p p s, or access ways indicating ng a fill pipe protruding <br /> from the ground on the property or adjacent to any structure <br /> located on the property? <br /> l2a- Are there currently any flooring, drains, or walls YesNo Unk <br /> located within the facility that are stained by substances <br /> other than water or are emitting.foul odors? <br /> 12b. Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there have been previously any flooring, -- <br /> drains, or walls located with the facility that are stained by <br /> substances other than water or are emitting foul odors? . <br /> fi 13a. If the property is served by a private well, or note Yes No Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that contaminants have been identified in the <br /> well or system that exceed guidelines applicable to the : <br /> water system? <br /> 13 b. if the property is served by a private well, or non- Yes No Unk . <br /> ' public water system, is there evidence or do you have prior <br /> knowledge that the well has been designated as <br /> contaminated by any government environmental/health <br /> agency? <br /> 14. Does the owner or occupant of the property have any Yes No nk. <br /> knowledge of environmental liens or governmental <br /> notification relating to past or recurrent violations of <br /> environmental laws with respect to the property or any <br /> facility located on the property? <br /> - 15a. Has the owner or occupant of the property been Yes No nk <br /> informed of the past existence of hazardous substances or <br /> petroleum products with respect to the property or any <br /> facility located on the property? <br /> ' V <br /> Initials <br /> 4 <br />