Laserfiche WebLink
Rev 2/23/2001 <br /> Page 3 of G <br /> I Oa Are there currently any registered or unregistered YesNa Unk <br /> storage tanks (above or underground) located on the <br /> property? <br /> I Ob Did you observe evidence or do you have any prior Yes (N)o Unk <br /> knowledge that there has been previously, any registered or <br /> unregistered storage tanks (above or underground) located <br /> on the property,' <br /> 0 <br /> I I a Are there currently any vent pipes, fill pipes, or access Yes No Unk <br /> z ways indicating a fill pipe protruding from the ground on <br /> the property or adjacent to any structure located on the <br /> property? <br /> I 1 b Did you observe evidence or do you have any prior Yes No Unk <br /> knowledge that there has been previously, any vent pipes, <br /> fill pipes, or access ways indicating a fill pipe protruding <br /> from the ground on the property or adjacent to any structure <br /> located on the property <br /> a 12a Are there currently any flooring, drains, or walls Yes No Unk <br /> located within the facility that are stained by substances <br /> other that water or are emitting foul odors? <br /> 12b Did you observe evidence or do you have any prior Yes Of) Unk <br /> knowledge that there has been previously,any flooring, <br /> drains, or walls located with the facility that are stained by <br /> substances other that water or are emitting foul odors9 <br /> 13a 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 contaminants have been identified in the <br /> well or system that exceed guidelines applicable to the <br /> water system? <br /> l 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 (DO <br /> Unk <br /> knowledge of environmental bens 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 S <br /> Unk <br /> informed of the past existence of hazardous s ubstances or <br /> petroleum products with respect to the property or any <br /> fatality located on the property? <br /> initials <br />