Real Estate Environmental Questionnaire

REAL ESTATE ENVIRONMENTAL QUESTIONNAIRE

Owner/Seller Name:    Recipient/Buyer Name:

Property Identification

Year of initial development or substantial improvement:

Party Contact Information

Environmental Conditions and History

1. Hazardous substances (storage, treatment, disposal, or known contamination) present on the property? Yes No

2. Underground storage tanks (USTs) currently or historically on site (installed, removed, or closed)? Yes No

3. Active or abandoned oil, gas, monitoring or injection wells on subject property? Yes No

4. Presence or removal of asbestos-containing materials (ACM)? Yes No

5. Presence of lead-based paint (residential structures built before 1978) or lead-contaminated soil? Yes No

6. Mold, persistent moisture intrusion, or water damage discovered on property? Yes No

7. Radon testing or mitigation systems installed or tests indicating elevated radon? Yes No

8. Prior disposal, burial, or fill placement on the property (authorized or unauthorized)? Yes No

9. Any known releases, spills, discharges, or cleanup actions (whether or not reported)? Yes No

10. Environmental assessments or reports available for the property (Phase I, Phase II, remediation reports)? Yes No

11. Any environmental liens, notices, enforcement orders, or land use restrictions affecting the property? Yes No

12. Wetlands, floodplain designations, protected habitat, or other ecological constraints on or adjacent to the property? Yes No

13. Known contamination or environmental conditions on adjacent properties that may affect subject property? Yes No

14. Historic uses of the property (examples: gas station, dry cleaner, manufacturing, agricultural pesticide application, waste disposal, mining)?

Available Documents

Please check documents that are in Owner's possession or control: Phase I Environmental Site Assessment Phase II Site Investigation Remediation/Closure Reports UST removal/closure documentation Asbestos survey Lead paint inspection Radon test/mitigation documentation Other (describe below)

Owner Representations, Certification and Indemnity

Owner represents that the responses in this Questionnaire are true and correct to Owner's actual knowledge as of the date of signature. Owner's knowledge for purposes of this Questionnaire means actual, current, personal knowledge and does not include constructive or inquiry notice or information that would be revealed by an environmental assessment conducted by a qualified third party. Owner certifies that all documents in Owner's possession responsive to the matters in this Questionnaire will be provided to Recipient promptly upon request.

Owner shall defend, indemnify and hold harmless Recipient from and against any claims, losses, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of a material inaccuracy in Owner's representations contained herein or Owner's failure to disclose, prior to the date of closing or transfer, any known environmental condition described in this Questionnaire that causes liability to attach to the property after transfer. This indemnity obligation shall survive closing or transfer.

Recipient is advised that this Questionnaire is not a substitute for a full environmental assessment. Recipient is entitled and encouraged to conduct its own inspections, tests, and due diligence investigations at Recipient's expense. Owner makes no warranty as to the environmental condition of the property except as expressly set forth in any separate written agreement between the parties.

Additional Remarks

Acknowledgement

By signing below, Owner certifies under penalty of perjury that the foregoing statements are true and accurate to the best of Owner's knowledge, and Recipient acknowledges receipt of this completed Questionnaire.

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