ENVIRONMENTAL QUESTIONNAIRE

& DISCLOSURE STATEMENT

INSTRUCTIONS: In order to evaluate the suitability of the property as collateral for a loan, it will be necessary for the current owner of the property to complete this questionnaire. Do not leave any questions unanswered. In order to fully complete this questionnaire, it may be necessary to communicate with past owners, property managers and current occupants at the property. If insufficient space is provided for the Comments in Section D of this questionnaire, please attach additional pages as applicable.

Please attach copies of any Environmental Assessment Reports performed on the property within the past 5 years.

  1. CURRENT OWNER/USES OF THE PROPERTY
  1. Name of current owner(s) and date of purchase: ______
  2. Property address and current use(s):

______

______

  1. Date of construction for all facilities on the property and dates of any substantial renovations:______

______

B. INSURANCE

1. Name and telephone number of Insurance Company, policy number and type/amounts of owner’s coverage for

environmental claims:

______

______

2. Description of any environmentally-related claims made under the insurance policy:

______

______

C. ENVIRONMENTAL QUESTIONS / Yes / No / Unk / N/A
  1. Is the property or any adjoining property currently used for an industrial use?

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

3. Is the property or any adjoining property currently used as a gasoline station, motor repair facility, commercial printing facility, dry cleaners, photo developing laboratory, junkyard or landfill, for waste treatment storage, disposal, or processing, or as a recycling facility?
4. To the best of your knowledge, in the past has the property or any adjoining property been used as a gasoline station, motor repair facility, commercial printing facility, dry cleaners, photo developing laboratory, junkyard or landfill, for waste treatment storage, disposal, or processing, or a recycling facility?
5. Is there currently a transformer, capacitor, or any hydraulic equipment for which there are any records indicating the presence of Polychlorinated Biphenyls (PCBs)?
C. ENVIRONMENTAL QUESTIONS / Yes / No / Unk / N/A
  1. Is there currently any asbestos in the construction materials used for the structures on the property?

7. Are any of the occupants of the property listed in any government records? (Federal National Priorities List (NPL or Superfund list), Federal Superfund liens database, Federal CERCLIS list of known or suspect hazardous waste sites, Federal Resource Conservation and Recovery Act (RCRA) list of facilities disposing of hazardous waste, Federal PCB activity database, Federal Toxic Chemical Release Inventory System database, known or suspect sites on the state hazardous waste list, former manufactured gas site list, state underground storage tank (UST) list, state leaking underground storage tank (LUST) list, state landfill/solid waste facility list, or state hazardous substance and petroleum product spills list.)
  1. Are there currently, or to the best of your knowledge have there previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers of greater than 5 gallon (19 L) in volume or 50 gallon (190 L) in the aggregate, stored on or used at the property?

  1. Are there currently, or to the best of your knowledge have there previously been, any industrial drums (typically 55 gallon) (208 L) or sacks of chemicals located on the property?

  1. Are there currently, or to the best of your knowledge have there previously been, any hazardous substances or petroleum products handled on the property?

  1. Is there currently or to the best of your knowledge has there previously been, any evidence of dumping or spills of chemicals or hazardous substance on the property?

  1. Is there currently any stained soil or any evidence of distressed vegetation, flora or fauna on the property?

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

  1. Are there currently, or to the best of your knowledge have there previously been, any registered or unregistered storage tanks (either above-ground or under-ground) on the property?

  1. Is there currently, or to the best or your knowledge has there previously been, any contaminated soil or contaminated groundwater at the property?

  1. Is there currently, or to the best of your knowledge has there previously been, a remediation plan implemented at the property?

  1. Are there currently, or to the best of your knowledge have there previously been, any vent pipes, fill pipes, or other access ways indicating a fill pipe protruding from the ground on the property?

  1. Are there currently, or to the best of your knowledge have there previously been, any deed restrictions associated with remedial action at the property?

C. ENVIRONMENTAL QUESTIONS / Yes / No / Unk / N/A
  1. Is wastewater discharged on or adjacent to the property other than storm water into a storm drain?

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

  1. If the property is served by a private well or nonpublic water system, have contaminants 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?

  1. To the best of your knowledge, are there any environmental liens or governmental notifications relating to past or recurrent violations of environmental laws with respect to any occupant of the property?

  1. To the best or your knowledge, have any environmental site assessments of the property been performed that indicated the presence of hazardous substances or petroleum products on, or contamination of, the property or indicated recommendations for further assessment of the property?

  1. To the best or your knowledge, are there any past, threatened, or pending lawsuits or administrative proceedings concerning a release of or threatened release of any hazardous substance or petroleum products at the property?

  1. COMMENTS FOR ANY AFFIRMATIVE ANSWERS TO ENVIRONMENTAL QUESTIONS
(Please indicate question number and corresponding comment)

Important Notice Regarding

“All Appropriate Inquiries” rules, “Innocent Landowner Defense” and Liability for Environmentally Impacted Real Estate

While North Island Credit Union is not responsible for environmental issues or related liabilities for cleanup of properties impacted by hazardous materials or conditions, we think it is important that you consider the importance of performing due diligence investigation of the property you are planning to purchase or refinance. North Island Credit Union may perform various levels of environmental due diligence in the course of a loan application but our investigations will not necessarily relieve you of the responsibility to perform higher and more appropriate levels of due diligence. This may include Phase 1 or higher environmental investigations performed by licensed environmental engineers.

Important!

Failure to perform “All Appropriate Inquiries” can expose you to significant liability for environmental cleanup of your property even though the property may have been impacted by the actions of a previous owner or damage from adjacent or nearby properties! By performing appropriate levels of investigation within prescribed timeframes you may preserve some rights and liability protection as an “Innocent Landowner”.

We strongly suggest that you consider the importance of performing an appropriate level of due diligence prior to entering into any real estate transaction. North Island Credit Union is not qualified to provide you with guidance or advice regarding “All Appropriate Inquiries” and we suggest that you seek the advice of:

  • A qualified environmental engineer
  • A qualified real estate professional
  • Your own legal counsel
  • Federal, State or Local environmental protection agencies

More information about this very important subject can be obtained from the following web sites and through a search for “All Appropriate Inquiries” on the internet:


By signing below, the owner of the subject property certifies that he/she/they are familiar with the operations presently conducted at the property; have made diligent inquiries as necessary to complete the questionnaire; and further declare that to the best of his/her/their knowledge, the information provided is true and correct.
Completed By: ______
Property Owner(s) Date
By signing below, theprospective buyer of the subject property certifies that he/she/they have received and reviewed a copy of the completed/executed Environmental Questionnaire and Disclosure Statement.
Reviewed By:______
Buyer(s) (if applicable) Date

Rev 7/2008Page 1