Environmental Survey

Name of Organization Date
Please answer the following questions as best as possible.
Subject Property Information
Is the property presently used for the manufacture, packaging, processing, storage, or repair/rehabilitation of any of the following items?
Yes No   Paint Chemicals Wood Preservation Rubber Products Metal Products / Platin Furniture Explosives Petroleum Textiles Plastics Fertilizer Pulp / Paper Products Glass Products Pesticides Motor Vehicles / Parts Jewelry
Does the property contain, or presently being used for any of the following services?
Yes No   Gas Station Plant Nursery Dry Cleaning Others Using Chemicals Auto / Bus Repair / Painting Gas Pumps Fuel Storage Tanks (above ground) Fuel Storage Tanks (buried)
Yes No   Are hazardous or toxic wastes generated or stored on the property? Does any structure on the property contain asbestos material? Does any structure on the property contain formaldehyde foam insulation material? Is radon gas known to emanate from the soil located on the property? Are polychlorinated biphenyls (PCB's) present on the property, in electrical transformers, or other equipment? Are PCB's present in electrical transformers, capacitor, or other pieces of equipment that service the property? Are any above or below ground pipelines located on the property? Is fuel burning equipment used on the property? Is waste water discharged to surface waters, septic systems, or holding ponds on or from the property? Have pesticides, herbicides, or other agricultural chemicals ever been mixed, formulated, rinsed, or disposed of on the property? Have pesticides, herbicides, or other agricultural chemicals ever been applied to the property? In previous years, was the property subject to a "yes"? answer to any of the above questions?
Adjacent Property
Yes No   Do you have knowledge of any hazardous or toxic wastes on any of the properties adjacent to the property? Have any adjacent property ever been used for industrial, manufacturing, refining, or processing purposes? Are there (or were there at any time) any disposal facilities, dump sites, or facilities involving hazardous water/toxic materials within a 2,000 foot radius from the subject property? Is radon gas known to emanate from the soil located on the property? Do you have knowledge of any chemical accidents or spills involving the properties adjacent to or surrounding the subject property?
Does the adjacent property contain or is it presently used for any of the following services?
Yes No   Gas Station Plant Nursery Dry Cleaning Others Using Chemicals Auto / Bus Repair / Painting Gas Pumps Fuel Storage Tanks (above ground) Fuel Storage Tanks (buried)
General Concerns
Yes No   Do any environmental concerns exist pertaining to surface water runoff, water supply, well or ground water contamination, air pollution, waste disposal, or other factors related to this property which might be considered hazardous?
INSURANCE
Yes No   Do you know of any reason why environmental conditions might influence the insurability of the property?
Legal Actions
Yes No   Are you aware of any hazardous conditions now or previously existing on the property, which represent violations of local, state, or federal environmental or public health statutes and laws? Is the property currently the subject of environmental or public health litigation of administrative action from private parties or public officials?
*** PLEASE NOTE: If you answered "yes"? to any of the above questions, please attach a detailed explanation.
Acknowledgement of Environmental Survey:
I acknowledge that I have read and answered the above questions and affirm that the information provided herein is true and correct to the best of my ability, and I will promptly High Tower Capital if I become aware of information altering these answers.