Real Estate Environmental Questionnaire and Disclosure Statement

Transcription

1 Real Estate Environmental Questionnaire and Disclosure Statement The following pages comprise an Environmental Questionnaire and Disclosure Statement which must be completed by the loan applicant before the loan request can be considered. Please answer all questions as completely as possible so that your loan request can be evaluated promptly. If the space provided for your detailed responses is not sufficient, please attach additional pages to this questionnaire as necessary. PART 1 : GENERAL BACKGROUND INFORMATION Loan Applicant Owner of Property Property Address Site Manager or Site Contact Telephone No. of Manager/Contact Current Tenants No. and Size of Buildings (sq. ft.) Date(s) of Construction Type of Construction (slab-ongrade, basement, masonry block walls,

2 PART 1 : GENERAL BACKGROUND INFORMATION (CONTINUED) Property Acreage Utilities (Water, Sewers, Heat, etc.) Septic System(s) Previously In Use at Property? (If yes, supply no., locations, and approx. dates.) Current Use (s) of Property (as specifically as possible) Past Use (s) of Property (as specifically as possible) Planned Future Uses of Property (as specifically as possible) Excavation, Earthmoving, or Laying of Utilities Expected? (Provide details.) Significant Demolition or Renovation Planned? (Provide details.)

3 PART 2: QUESTIONNAIRE Please circle the correct response and provide detailed answers for all questions answered with "YES." 1. Is the property or any adjoining property currently used for an industrial use. If so, please describe. Subject Site Adjoining Property 2. To the best of your knowledge, has the property or any adjoining property been used for an industrial use in the past? If so, please describe. Subject Site Adjoining Property 3. Do current or past uses of the property include any of the following: dry cleaning, embalming, furniture stripping, vehicle maintenance and repair, production or application of paints and lacquers, ink production and formulation, photo developing, printing, tanning, wood treatment and preservation, or any other operation which involves the generation of regulated amounts of hazardous waste? If so, please describe. 4. Is the property or any adjoining property currently an active or abandoned gas station, junkyard, landfill, or waste treatment, storage, disposal, processing, or recycling facility? If so, please describe.

4 Subject Site Adjoining Property 5. To the best of your knowledge, has the property or any adjoining property been used in the past as a gas station, junkyard, landfill, or waste treatment, storage, disposal, processing, or recycling facility? If so, please describe. Subject Site Adjoining Property 6. Are there currently, or to the best or your knowledge have there been previously, any automotive or industrial batteries in significant quantities, 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? If so, please describe

5 7. Are there currently, or to the best of your knowledge have there been previously, any industrial drums (typically 55 gallon) or sacks of chemicals located on the property or at the facility? If so, please describe. 8. Has fill dirt been brought onto the property which originated from a contaminated site or which is of an unknown origin? If so, please describe. 9. 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? If so, please describe.

6 10. Is there currently, or to the best of your knowledge has there been previously, any stained soil on the property? If so, please describe. 11. Are there currently, or to the best of your knowledge have there been previously, any registered or unregistered storage tanks (underground or above ground) located on the property? If so, please describe. 12. 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? If so, please describe. 13. 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 which are emitting foul odors? If so, please describe. 14. If the property is served by a private well or non-public water system, have contaminants been

7 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? If so, please describe. 15. 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? If so, please describe. 16. Has the owner or occupant of the property been informed of the past or current existence of hazardous substances or petroleum products on or beneath the property or of environmental violations with respect to the property or any facility located on the property? If so, please describe.

8 17. 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? If so, please describe and please attach a copy of the report. 18. Does the owner or occupant of the property know of any past, threatened, or pending lawsuits or administrative proceedings concerning a release or threatened release of any hazardous substance or petroleum products involving the property by any owner or occupant of the property? If so, please describe. 19. Does the property discharge waste water, other than storm water, directly to a ditch or stream on or near the property? If so, please describe.

9 20. To the best of your knowledge, have any hazardous substances or petroleum products, unidentified waste materials, tires, automotive or industrial batteries or any other waste materials been dumped above grade, buried and/or burned on the property? If so, please describe. 21. Is there a transformer, capacitor or any hydraulic equipment for which there are any records indicating the presence of PCBs? If so, please describe. 22. Does the owner or occupant of the site presently have, is it required to have, or has it applied for any environmental licenses or permits issued by any federal, state, or local governmental body, including air or water permits? If so, please describe and attach copies of licenses or permits. 23. To the best of your knowledge, have pesticides, herbicides, or other agricultural chemicals been applied to the property? If so, please describe.

10 24. Is the property located near a floodplain, wetland, lake, river, stream, or other sensitive ecological area? If so, please describe. 25. To the best of your knowledge, has a survey ever been conducted to determine whether asbestos-containing materials may be present on the property or to determine the type, amount, location, and condition of such materials? If so, please describe and please attach a copy of the survey results. 26. Are there currently, or to the best of your knowledge have there ever been, asbestos-containing materials in the building(s) at the property? If so, please describe. 27. To the best of your knowledge, has a survey, assessment, or any testing ever been performed to evaluate the potential for lead-based paint or other lead hazards at the property? If so, please describe and please attach any assessment or testing results. The undersigned represents and warrants, individually and on behalf of the Company, that the information provided in response to this Questionnaire and Disclosure Statement is true and accurate to the best

11 information, knowledge and belief of the undersigned. The undersigned further represents that (s)he is authorized to provide the information requested on this questionnaire, and that the information provided herein has been disclosed after all appropriate inquiry necessary to confirm its accuracy and completeness. The undersigned recognizes that lender will rely upon the truth and accuracy of all information contained in this questionnaire in evaluating an application for credit, and the acceptability of the property as collateral. Signature of Loan Applicant Date Print Name and Title of Applicant Signature of Preparer Date Print Name and Title of Preparer (if different from Loan Applicant) Signature of Property Owner Date Print Name and Title of Owner (if different from Loan Applicant)