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°J�j S U w ow 1201 <br /> Rev 2/23!2001 <br /> l 4-e— ' 2�!�j �� Cq vea—V& Page i of G <br /> TRANSACTION SCREEN QUESTIONNAIRE <br /> This questionnaire has been prepared by Condor Earth Technologies, Inc (Preparer) by request <br /> from (User) in order to obtain information regarding the proposed (Site) The <br /> objective of this questionnaire is to provide the User with information regarding the presence or <br /> likely presence of any hazardous substances or petroleum products on the property that may <br /> present a material risk of harm to public health or to the environment Information provided by <br /> t this questionnaire will be used to identify recognized environmental conditions existing on the <br /> Site that may or may not require additional research The questionnaire is provided on a <br /> voluntary basis by the respondent as part of a customary practice for conducting an <br /> x Environmental Site Assessment on a specific parcel of real estate Please respond to the best of <br /> your ability To provide further information, please describe reason for any affirmative answers <br /> on a separate sheet of paper <br /> RESPONDENT(CHECK ONE) <br /> Owner ] Occupant [] Preparer(during Site visit) [] <br /> Question Answer <br /> la Is this Site used for an industrial use? Yes No Unk <br /> 1 b Is any adjoining property used for an industrial use? Yes No Unk <br /> 2a Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that the property has been used for an industrial <br /> use in the past9 <br /> 2b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that any adjoining property has been used for an <br /> industrial use in the past? <br /> 3a Is the property used as a gasoline station, motor repair Yes No Unk <br /> facility, dry cleaners, photo developing laboratory, <br /> junkyard of landfill, or as a waste treatment, storage, <br /> disposal, processing, or recycling facility(if applicable, <br /> identify which)? <br /> 3b Is any adjoining property used as a gasoline station, Yes ONO Unk <br /> t motor repair facility, dry cleaners, photo developing <br /> laboratory,junkyard of landfill, or as a waste treatment, <br /> storage, disposal, processing, or recycling facility (if <br /> applicable, identify which)? <br /> 4a Did you observe evidence or do you have any prior Yes Na Unk <br /> knowledge that the property has been used as a gasoline <br /> 4 <br /> station, motor repair facility,dry cleaners, photo developing <br /> laboratory,junkyard of landfill, or as a waste treatment, <br /> storage, disposal, processing, or recycling facility(if <br /> r . applicable, identify which)? <br /> R P <br /> ;� Initials <br />