Environmental Questionnaire - TaliMar Financial

Name *

First

Last

E-Mail *

Phone

Subject Property

Address Line 1

Address Line 2

City

State

Zip Code

(1) Is the Property or any adjoining property used for industrial use?

(2) To the best of your knowledge, has the property or any adjoining property been used for an industrial use in the past?

(3) Is the property or any adjoining property presently used as a gasoline station, motor repair facility, commercial printing facility, dry cleaners, photo developing laboratory, junkyard or landfill, or as a waste treatment, storage, disposal, processing, or recycling facility?

(4) To the best of your knowledge, has the property or any adjoining property been used in the past as a gasoline station, motor repair facility, commercial printing facility, dry cleaners, photo developing laboratory, junkyard or landfill, or as a waste treatment, storage, disposal, processing, or recycling facility?

(5) Are there currently, or to the best of your knowledge, have there been previously, any damaged or discarded automotive or industrial batteries, or pesticides, paints, or other chemicals in individual containers of greater than five gallons in volume or fifty gallons in the aggregate, stored on or used at the property or at the facility?

(6) Are there currently, or to the best of your knowledge has there been previously, any industrial drums (typically 55 gallon) or sacks of chemicals located on the property or at the facility?

(7) Has Fill Dirt been brought onto the property which originated from a contaminated site or which is of an unknown origin?

(8) Are there currently, or to the best of your knowledge have there been previously, any pits, ponds, or lagoons located on the property in connection with waste treatment or waste disposal?

(9) Is there currently, or to the best of your knowledge has there been previously, any stained soil on the property?

(10) Are there currently, or to the best of your knowledge have there been previously, any registered or unregistered storage tanks (above or underground) located on the property?

(11) Are there currently, or to the best of your knowledge, have there been previously any vent pipes, fill pipes or access ways indicating a fill pipe protruding from the ground on the property or adjacent to any structure located on the property?

(12) Are there currently, or to the best of your knowledge, have there been previously any flooring, drains, or walls located within the facility that are stained by substances other than water or are emitting foul odors?

(13) If the property is served by a private well or non-public water system, have contaminates been identified in the well or system that exceed guidelines applicable to the water system or has the well been designated as contaminated by any government environmental/health agency?

(14) Does the owner or occupant of the property have any knowledge of environmental liens or governmental notification relating to past or current violations of environmental laws with respect to the property or any facility located on the property?

(15) Has the owner or occupant of the property been informed of the past or current existence of hazardous substances or petroleum products or environmental violations with respect to the property or any facility located on the property?

(16) Does the owner or occupant of the property have any knowledge of any environmental site assessment of the property or facility that indicated the presence of hazardous substances or petroleum products on, or contamination of , the property or recommended further assessment of the property?

(17) Does the owner or occupant of the property know of any past, threatened or pending lawsuits or administrative proceedings concerning a release of any hazardous substances or petroleum products involving the property by any owner or occupant of the property?

(18) Does the property discharge waste water on or adjacent to the property other than storm water or into a sanitary sewer system?

(19) To the best of your knowledge, have any hazardous substances or petroleum products, unidentified waste materials, tires, automotive or industrial batteries, or other waste materials been dumped above ground, buried and/or burned on the property?

(20) Is there a transformer, capacitor or any hydraulic equipment for which there are any records indicating the presence of PCB’s?

By signing below, I acknowledge that I have read this questionnaire and have responded to the issues and questions posed therein to the best of my knowledge.

Clear Signature