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Text File  |  1997-10-13  |  5.9 KB  |  172 lines
  1. ' Edited Form File: U:\Pangaea\Esa4.frm
  2. ' Date Created:    19-Jun-1997 08:22:34
  3. '
  4. ' Fonts
  5. F,1,100,1,0,0,Arial Narrow
  6. F,2,90,0,0,0,Arial Narrow
  7. F,3,60,0,0,0,Arial Narrow
  8. F,4,70,0,0,0,Arial Narrow
  9. F,5,70,1,0,0,Arial Narrow
  10. F,6,50,1,0,0,Arial Narrow
  11. '
  12. P,1,4,Form710
  13. '
  14. ' Open Rectangles
  15. R,1,1,617,1215,0,1,0
  16. '
  17. ' Filled Rectangles
  18. R,13,22,593,23,1,1,0
  19. R,58,129,25,1,1,1,0
  20. R,128,129,25,1,1,1,0
  21. R,223,129,25,1,1,1,0
  22. R,366,129,26,1,1,1,0
  23. R,436,129,25,1,1,1,0
  24. R,531,129,25,1,1,1,0
  25. R,221,168,25,1,1,1,0
  26. R,291,168,25,1,1,1,0
  27. R,385,168,26,1,1,1,0
  28. R,13,188,593,23,1,1,0
  29. R,57,281,25,1,1,1,0
  30. R,127,281,25,1,1,1,0
  31. R,222,281,25,1,1,1,0
  32. R,365,281,26,1,1,1,0
  33. R,435,281,25,1,1,1,0
  34. R,530,281,25,1,1,1,0
  35. R,220,319,25,1,1,1,0
  36. R,290,319,25,1,1,1,0
  37. R,384,319,26,1,1,1,0
  38. R,13,338,593,23,1,1,0
  39. R,477,425,25,1,1,1,0
  40. R,531,425,25,1,1,1,0
  41. R,477,451,25,1,1,1,0
  42. R,531,451,25,1,1,1,0
  43. R,477,476,25,1,1,1,0
  44. R,531,476,25,1,1,1,0
  45. R,13,499,593,22,1,1,0
  46. R,477,587,25,1,1,1,0
  47. R,531,587,25,1,1,1,0
  48. R,477,654,25,1,1,1,0
  49. R,531,654,25,1,1,1,0
  50. R,477,721,25,1,1,1,0
  51. R,531,721,25,1,1,1,0
  52. R,477,762,25,1,1,1,0
  53. R,531,762,25,1,1,1,0
  54. R,15,802,592,23,1,1,0
  55. R,477,847,25,1,1,1,0
  56. R,531,847,25,1,1,1,0
  57. R,13,963,593,23,1,1,0
  58. R,189,984,2,1,1,1,0
  59. R,81,1011,525,1,1,1,0
  60. R,15,1030,591,1,1,1,0
  61. R,15,1050,591,1,1,1,0
  62. R,15,1069,591,1,1,1,0
  63. R,15,1088,591,1,1,1,0
  64. R,15,1107,591,1,1,1,0
  65. R,15,1127,591,1,1,1,0
  66. R,15,1196,272,1,1,1,0
  67. R,296,1196,180,1,1,1,0
  68. R,486,1196,120,1,1,1,0
  69. '
  70. ' Lines
  71. '
  72. ' Images
  73. '
  74. ' Text Strings
  75. T,176,116,2,0,Unknown
  76. T,339,155,2,0,Unknown
  77. T,275,155,2,0,No
  78. T,234,140,2,0,Observed During Site Visit:
  79. T,201,155,2,0,Yes
  80. T,484,116,2,0,Unknown
  81. T,13,369,1,0,21.
  82. T,39,369,1,0,Do any of the following Federal governmental record systems list the property or any property within the
  83. T,39,382,1,0,circumference of the area noted below:
  84. T,420,116,2,0,No
  85. T,347,101,2,0,Occupants (if applicable):
  86. T,347,116,2,0,Yes
  87. T,112,116,2,0,No
  88. T,13,49,1,0,19.
  89. T,39,49,1,0,To the best of your knowledge, have any hazardous substances or petroleum products, unidentified waste
  90. T,39,63,1,0,materials, tires, automotive or industrial batteries or any other waste materials been dumped above grade,
  91. T,39,76,1,0,buried and/or burned on the property?
  92. T,39,101,2,0,Owner:
  93. T,5,1216,4,0,    Copyright 1994 Environmental Assessment Association, 8383 East Evans Road, Scottsdale Arizona 85260 USA
  94. T,1,1227,4,0,This form may be reproduced without written consent, however, the \"Environmental Assessment Association\" must be acknowledged and credited.
  95. T,97,1237,3,0,This form was reproduced by United Systems Software Company - 955 E. Javelina Avenue - Suite 106 - Mesa, AZ  85204 - (800) 969-8727
  96. T,583,1215,5,0,Pg 4 of 4
  97. T,582,1228,5,0,Form 710
  98. T,39,116,2,0,Yes
  99. T,175,268,2,0,Unknown
  100. T,338,306,2,0,Unknown
  101. T,274,306,2,0,No
  102. T,233,291,2,0,Observed During Site Visit:
  103. T,200,306,2,0,Yes
  104. T,483,268,2,0,Unknown
  105. T,419,268,2,0,No
  106. T,346,252,2,0,Occupants (if applicable):
  107. T,346,268,2,0,Yes
  108. T,111,268,2,0,No
  109. T,13,214,1,0,20.
  110. T,38,214,1,0,Is there a transformer, capacitor, or any hydraulic equipment for which there are any records indicating the
  111. T,38,228,1,0,presents of PCB's?
  112. T,38,252,2,0,Owner:
  113. T,38,268,2,0,Yes
  114. T,3,1218,6,0,C
  115. T,13,530,1,0,22.
  116. T,39,530,1,0,Do any of the following state record systems list the property or any property within the circumference of
  117. T,39,543,1,0,the area noted below:
  118. T,15,833,1,0,23.
  119. T,41,833,1,0,Based upon a review of fire insurance maps
  120. T,41,846,1,0,or consultation with the local fire department
  121. T,41,859,1,0,serving the property, all as specified in the
  122. T,41,872,1,0,guide, are any buildings or other
  123. T,41,885,1,0,improvements on the property or on an
  124. T,41,899,1,0,adjoining property identified as having been
  125. T,41,912,1,0,used for an industrial use or uses likely to
  126. T,41,925,1,0,lead to contamination of the property?
  127. T,39,412,2,0,National Properties List - within 1.0 mile (1.6 Km)
  128. T,39,437,2,0,CERCLIS List - within 0.5 mile (0.8 Km)
  129. T,39,462,2,0,RCRA TSD Facilities - within 1.0 mile (1.6 Km)
  130. T,515,412,2,0,No
  131. T,457,412,2,0,Yes
  132. T,263,412,2,0,.............................................................
  133. T,515,437,2,0,No
  134. T,457,437,2,0,Yes
  135. T,219,437,2,0,............................................................................
  136. T,515,462,2,0,No
  137. T,457,462,2,0,Yes
  138. T,252,462,2,0,.................................................................
  139. T,515,573,2,0,No
  140. T,457,573,2,0,Yes
  141. T,261,573,2,0,..............................................................
  142. T,39,573,2,0,List maintained by state environmental agency of
  143. T,39,587,2,0,hazardous waste sites identified for investigation
  144. T,39,600,2,0,or remediation that is the state agency equivalent
  145. T,39,613,2,0,to NPL - within approximately 1.0 mile (1.6 Km)?
  146. T,515,641,2,0,No
  147. T,457,641,2,0,Yes
  148. T,261,641,2,0,..............................................................
  149. T,39,641,2,0,List maintained by state environmental agency of
  150. T,39,654,2,0,sites identified for investigation or remediation that
  151. T,39,667,2,0,is the state equivalent to CERCLIS - within 0.5
  152. T,39,681,2,0,mile (0.8 Km)?
  153. T,515,708,2,0,No
  154. T,457,708,2,0,Yes
  155. T,257,708,2,0,...............................................................
  156. T,39,708,2,0,Leaking Underground Storage Tank (LUST) List -
  157. T,39,722,2,0,within 0.5 mile (0.8 Km)?
  158. T,515,749,2,0,No
  159. T,457,749,2,0,Yes
  160. T,250,749,2,0,..................................................................
  161. T,39,749,2,0,Solid Waste/Landfill Facilities - within 0.5 mile
  162. T,39,762,2,0,(0.8 Km)?
  163. T,515,834,2,0,No
  164. T,457,834,2,0,Yes
  165. T,280,834,2,0,........................................................
  166. T,15,996,1,0,COMMENTS
  167. T,3,1131,1,0,Preparer represents that to the best of the preparer's knowledge the above statements and facts are true and correct,
  168. T,4,1144,1,0,and to the best of the preparer's actual knowledge, no material facts have been suppressed or misstated.
  169. T,70,1198,2,0,Environmental Inspector's Signature
  170. T,352,1198,2,0,EAA Member #
  171. T,535,1198,2,0,Date
  172.