ENVIRONMENTAL QUESTIONNAIRE - REAL ESTATE SECURED LOANS

Transcription

1 ENVIRONMENTAL QUESTIONNAIRE - REAL ESTATE SECURED LOANS Borrower: Property Known As: Property Address: City State NC Zip Code INSTRUCTIONS: For all loans, complete pages 1-3, answering all questions. If you answer yes to question 9 to the questionnaire, please complete pages 4 and 5. Please return all 5 pages for submission to SBA. 1. To the ext possible, determine the prior, curr and planned uses for the property. If any of these involve operations that used or use toxic chemicals, require a Phase I audit. 2. To the ext possible, determine the prior, curr and planned uses of all adjoining property. If any of these involve operations that used or use toxic chemicals, require a Phase I audit. 1 of 5

2 No. Question (to be answered by Borrower) YES NO Attach m? 1 Has the site, its owners or occupants ever been the focus of environmal inquiry or investigation by a local, state or federal agency? If so, Provide a complete explanation with supporting attachms. 2 Has any prior or curr occupant or owner of the site ever been cited, fined, or paid penalties in any manner as a result of environmal issues on site? If so, Provide a complete explanation with supporting attachms. 3 Has a Phase I ESA or any other environmal report ever been prepared by a consultant for this property? If so, you must provide a copy of each report for the Bank s review with this completed questionnaire. 4 Have any of environmally sensitive activities listed below taken place at the property historically either as a primary activity or in conjunction with activities onsite? If yes, complete Table A (below). 5 Are any of the above applicable to the curr use of the property: If yes, complete Table A (below). 6 Was the property built before 1981? If so, provide a copy of all information concerning asbestos with this completed questionnaire. 7 Has the property ever been investigated for or had a documed presence of lead based paint, indoor air quality problem or mold? If so, provide a copy of all information concerning these issues with this completed questionnaire. 8 Historically, did the property ever have any underground or above ground storage tanks (e.g., heating oil, backup generators)? If underground storage tanks were removed from the property, provide documation that they have been removed and have received regulatory agency closure. 9 Are any underground storage tanks or above-ground storage tanks currly located on the property? If so, complete the Environmal Questionnaire for Loans to Facilities with Underground Storage Tanks (USTs) Secured by Real Estate. (pages 3 & 4 of this docum) If not, do not complete pages 4&5. 10 Are any regulated, toxic or hazardous chemicals or materials stored, consumed on or disposed of from the property? If so, describe them and their use, storage and handling (including whether or not Material Safety Data Sheets are pres available onsite): 11 Have there been any spills, leaks, or other reportable releases of chemicals on the property or migration of chemicals onto the property from an offsite source? If so, provide copy of all reports and regulatory agency correspondence related to the incid(s). 2 of 5

3 Histo rical TABLE A - Environmally Sensitive Activities (Check all that apply) Histo rical Histor ical Airport or aircraft maintenance Incineration, furnace or air Photochemical laboratories emissions of any nature Analytical testing Inks, dye and paint manufacturing or use Plastic/fiberglass fabrication/manufacturing Asphalt or cem plant Junk/scrap yard Power plant Automotive repair or service Livestock feed lots or manure Printing industries (mechanical or autobody) stockpiles Chemical manufacturing/treatm Machine shops Railroad yard/spur Dairy, meat and food processing Metal fabrication or production Recycling processes Dry cleaning or laundry facilities Metal plating or finishing Textile and leather manufacturing Explosives manufacturing Military base Trash, debris or waste disposal onsite including landfilling or open dumps Fertilizer manufacturing Mining or quarry activities Treatm, storage or disposal facility for municipal, special, regulated or hazardous wastes Foundries/smelters/casting operations Motor vehicle maintenance/repairs Vehicle/equipm degreasing/washing Freight terminals Oil and gas production/refining Waste treatm processes Gasoline station or convenience Paper manufacturing Wood preservation or finishing store Herbicide/pesticide manufacturing Pharmaceutical/medical production The purpose of this questionnaire is for the Borrower to idify and disclose environmal issues to the Bank related to the real estate collateral or related to the operations onsite, either past or pres. It is the Borrower s responsibility to obtain necessary information from the owner of the property in the ev that the subject loan is for a purchase transaction. This information will be considered as part of the loan application. Where description of conditions is requested, please provide them as an attachm to this docum with reference to the applicable question number. Discussion with your loan represative is recommended before commencing completion of this form. This questionnaire must be signed by the Borrower. CERTIFICATION BY THE BORROWER Required for ALL LOANS If the Borrower / Applicant is an individual: I, (Print Name), state to the best of my knowledge, information and belief that all of the facts stated in response to the questions and requests for information contained in the foregoing Environmal Questionnaire If the Borrower / Applicant is a corporation, partnership, or limited liability company: I, (Print Name), state that I am the (Print Title or Position) of (Print Applicant s Name), ("Applicant") and that I am authorized to execute this docum on behalf of the Applicant. I further state based in part upon my personal knowledge and on behalf of the Applicant, that to the best of my knowledge, information and belief that all of the facts stated in response to the questions and requests for information contained in the foregoing Environmal Questionnaire Signature Date Corporate Title CERTIFICATION BY THE SELLER OF THE PROPERTY Required for ALL LOANS done in participation with the U.S. Small Business Administration If the Seller of the Property is an individual: I, (Print Name), state to the best of my knowledge, information and belief that all of the facts stated in response to the questions and requests for information contained in the foregoing Environmal Questionnaire If the Seller of the Property is a corporation, partnership, or limited liability company: I, (Print Name), state that I am the (Print Title or Position) of (Print Name of Seller), ("Seller") and that I am authorized to execute this docum on behalf of the Seller. I further state based in part upon my personal knowledge and on behalf of the Seller, that to the best of my knowledge, information and belief that all of the facts stated in response to the questions and requests for information contained in the foregoing Environmal Questionnaire Signature Date Corporate Title 3 of 5

4 Environmal Questionnaire for Loans to Facilities with Underground Storage Tanks (USTs) Secured by Real Estate (to be completed by the credit taker) The purpose of this questionnaire is for the Borrower to idify and disclose environmal issues to Self-Help related to the real estate collateral or related to the operations onsite, either past or pres. It is the Borrower s responsibility to obtain necessary information from the owner of the property in the ev that the subject loan is for a purchase transaction. This information will be considered as part of the loan application. Where description of conditions is requested, please provide them as an attachm to this docum with reference to the applicable question number. Discussion with your loan represative is recommended before commencing completion of this form. This questionnaire must be signed by the Borrower. Borrower: Property Known As: Property Address: City State Zip Code Please check the appropriate box for each question YES N/A NO 1. Has there ever been a release of any hazardous or regulated substances cleaning solvs, gasoline, etc.) on the subject site? (If not, skip to 2. question If so, has #5) the appropriate regulatory agency been notified in writing? (attach copy of letter) 3. If so, has remediation been completed and a closure letter received from appropriate regulatory agency? (attach copy of closure letter) If a release has occurred and remediation is currly underway (has not been completed), please provide an opinion letter from the environmal consultant of record attesting to the curr status of the remediation, when completion is expected, the remaining cost to complete remediation, and whether or not the site is eligible (and to what ext) for reimbursem under a state UST reimbursem program. 4. If a release has occurred and remediation has not taken place, has the site priority ranking or hazard risk rating by the appropriate state regulatory agency? 5. Are all tanks appropriately registered? 6. Are there any hydraulic lifts onsite that utilize underground reservoirs? Corrosion Protection 7. Is all piping and are all tanks on site made of fiberglass or steel clad with fiberglass? 8. Have all steel tanks been upgraded to meet corrosion protection lining or cathodic protection) 9. Has all steel piping been cathodically protected? Spill Protection 10. Have containm basins been installed on all fill pipes? Overfill Protection 11. Have all USTs been outfitted with overfill protection? Leak Detection - Piping 12. If your facility utilizes pressurized piping, have you installed devices that or restrict flow or sound an alarm if a leak is indicated? 13. If your piping is pressurized have you conducted annual tightness tests or 4 of 5

5 conducted monthly interstitial, vapor or groundwater monitoring or conducted monthly invory reconciliation? (circle method used) 14. If your facility utilizes below grade suction piping, does it operate at less atmospheric pressure and is it sloped so that conts will drain back into the storage tank if the suction is released? 15. If your facility utilizes suction piping and it does not meet the criteria of #12, do you have the piping tightness tested every three years or do you conduct monthly interstitial, vapor or groundwater monitoring or conduct monthly reconciliation? (circle method used) Leak Detection - Tanks 16. Do you conduct monthly invory control and tank tightness testing every years or monthly monitoring (interstitial, vapor or groundwater monitoring, or statistical invory reconciliation)? (circle method used) Financial Assurance 17. Has the appropriate financial assurance been established? (environmal impairm liability insurance, surety bonds, letter of credit, or eligibility under a solv state reimbursem program) (circle method used) History 18. Are the curr underground storage tanks the original underground (If not, provide closure information on any and all previous tanks) 19. Were any facilities previously located on the subject site that may have consumed significant quantities or hazardous or regulated substances (i.e., gasoline service station, dry cleaner, etc.) If so, please list the nature of facility or facilities in the space below. Space provided for any additional information as requested or required Question Number Additional Information I,, state to the best of my knowledge, information and belief that all of the stated in response to the questions and facts requests stated for in response information to contained the questions in the and foregoing requests Environmal for information Signature Date Corporate Title 5 of 5