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The term “property” refers to the physical piece of legally recorded land that is to be acquired.Please thoroughly answer the following questions. Use additional sheets of paper as necessary.Is or was the property used for governmental, commercial, light industrial or industrial activities? If yes, identify specific type and nature of activities. FORMCHECKBOX Yes FORMCHECKBOX NoAre any aboveground storage tanks (ASTs), underground storage tanks (UST), or leaking underground storage tanks present on property? If yes, identify the type, capacity, and condition of each tank. FORMCHECKBOX Yes FORMCHECKBOX No At any time, has any generation, treatment, storage, disposal, release, or spill of petroleum products, solid or hazardous substances and/or waste (to include pesticides, herbicides, or rodenticides) occurred on what is now your property, other than normal quantities of household substances? If yes, identify each type of activity, substance, and quantity. FORMCHECKBOX Yes FORMCHECKBOX NoAt any time, has a transportation facility (to include parking lots, railroad yards, or railroad or roadway right-of-way) been present on what is now your property? If yes, identify type of facility or activity. FORMCHECKBOX Yes FORMCHECKBOX NoHave you noticed any unusual odors or discolorations in your drinking water? FORMCHECKBOX Yes FORMCHECKBOX NoAt any time, has any environmental investigations been conducted by federal, state, or local agencies or private firms; or any environmental or Occupational Safety and Health Administration (OSHA) citations or notices of violation been issued regarding what is now your property? If yes, identify the type of investigation or violation, and the preparer or origin of the investigation or violation. FORMCHECKBOX Yes FORMCHECKBOX No The property owner(s) acknowledge that this certification regarding hazardous substances and/or waste is a material representation of fact on which the Hazard Mitigation Grant Program sub-grantee and other government entities rely on to execute the purchase of the property. The property owner(s) certify that the information contained herein is a full disclosure of all available information to the best of owner’s(s’) knowledge, and that owner(s) has exercised due diligence in obtaining all relevant information.PreparerSignatureDateName (Typed or Printed)TitleProperty Owner(s)SignatureDateName (Typed or Printed)SignatureDateName (Typed or Printed) Instructions for Completing the Hazardous Materials Property Survey/Individual Property Survey Form Why are we asking for this information about your property? Normal property transactions involve an inspection of the property by the buyer before the purchase occurs. One area of concern to buyers is the potential for hazardous materials liability. Sellers are usually required to provide assurance or evidence to the buyer that hazardous materials do not contaminate the property. This survey provides that assurance to the Government as well as provides some legal protection to the seller. If the survey indicates possible contamination, FEMA or your state or local government can provide guidance to the seller for addressing any hazardous-materials-related concerns. Points to consider when answering the survey questions: Please type or print. All property owners should be identified and participate in completing the survey, and sign the survey. Anyone who assists the property owner in completing the survey should be identified as a preparer. Answer the survey to the best of your knowledge; fully investigate each answer. Consult with previous owner(s) and/or neighbors whenever possible regarding past use of your property, underground storage tanks, presence of hazardous materials, and environmental violations or studies. Walk your property looking for anything unusual or previously unnoticed. Attach a sheet of paper to complete your answers, if necessary. Note any information of interest not specifically requested in the survey that might indicate contamination of the property by hazardous materials. On a residential property, commercial, and light industrial uses might include activities such as commercial auto repair in the home garage, paint stripping, hairdressing, woodworking, etc. Because not all in-home commercial activities involve hazardous materials, make sure to indicate the specific type of in-home commercial business activity under question #1. Many historic railroad yards, railroad rights-of-way, parking lots, and roadway rights-of-way have been abandoned and reverted back to adjoining landowners. If there was any previous transportation facility, note the specific use in question #4. (For example, the property might have been used to store heavy equipment or vehicles, or as a repair shop.) Retain a copy of the survey for your own records. Address your questions to your community’s point of contact. 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Holley"Steve Holley (Sullivan & Cromwell)KIM Wendy Barokas Joscelyn ZellSteve SklepowichBrad Smith (LCA)Tom Burt (LCA)Davehe Mark LevensonDeborah CaldwellScott M Greg Maffei Bill Neukom Tod Nielsen Michael Hall Barry MitzmanMichelle Williams Shelley OldsDoug Rosenthalq‡—n~„” "2'-=šŖ°ĄV f l | 8G•,G•,G•,G•,G•,G•,G•,G•,G•,G•,G•,G•,6=?J!“’•€’’ Check1Check2Check3Check4Check5Check6Check7Check8Check9Check10Check11Check12rˆo… #.›±W m 9 ‚˜•3(>«Įg } 9ŹĪ_ks ( ” œ ksļ69Ö ' / @Fļ69’’Christine ConwayQC:\My Documents\FEMA Haz Mit\Job Aids III\Hazardous Materials Property Survey.docChristine ConwayQC:\My Documents\FEMA Haz Mit\Job Aids III\Hazardous Materials Property Survey.docChristine ConwayQC:\My Documents\FEMA Haz Mit\Job Aids III\Hazardous Materials Property Survey.docChristine ConwayPC:\My Documents\FEMA Haz Mit\Job Aids II\Hazardous Materials Property Survey.docChristine ConwayYC:\My Documents\FEMA Haz Mit\Job Aids II\Forms II\Hazardous Materials Property Survey.docChristine ConwayYC:\My Documents\FEMA Haz Mit\Job Aids II\Forms II\Hazardous Materials Property Survey.docChristine ConwayYC:\My Documents\FEMA Haz Mit\Job Aids II\Forms II\Hazardous Materials Property Survey.doc Miss PixelLD:\FEMA Haz Mit\Forms\Phase II Forms\Hazardous Materials Property Survey.doc Miss PixelXD:\FEMA Haz Mit\Forms\Phase II Forms\Form II-14, Hazardous Materials Property Survey.doc Miss PixelXD:\FEMA Haz Mit\Forms\Phase II Forms\Form II-14, Hazardous Materials Property Survey.docQi¹ņ·ś&’‡*ķ0$L> ’Ü&gcčōy’ucJf ’īSw ’„Š„0żĘŠCJOJQJo(·š„Š„0żĘŠCJ OJQJo(·š„Š„0żĘŠCJ OJQJo(qš„h„˜žĘh. „h„˜žĘhOJQJo(·šucJfÜ&gcīSwQi¹‡*ķ0’’’’’’’’’’’’’’’’’’’’’’’@\“üRä““Ģü$OJQJ56OJQJ$56OJQJ<F$6OJQJbŹ' F$62OJQJbŹ'ü CDTUVWXYZklmnopq‰Š‹ŒœžŸ ”¢»¼½ĮĀĆĖĢĶÓŌÕÖpqrŅÓpq‚ƒ†‡˜™›œžŸ ”¢£¤„¦§mn€ƒ„•–˜™š›œžŸ ”¢£¤„  !"346789:;<=>?@AB(),->?ABCDEFGHIJKLM™š«¬Æ°ĮĀÄÅĘU V g h k l } ~ €  ‚ ƒ „ … † ‡ ˆ ‰ Š ‹ Œ Ž ’ “ ”  ž Ÿ   ” ¢ ² ³ “ µ ¶ · Ļ Š Õ Ö × ß ą å é ź ė ģ ķ ī ų ž ’         ! " , 2 3 4 5 6 7 O P Q R S · ó \“”īļ -.34678@@@†@Aˆ@@Ø@@Ŗ@@¬@@®@@°@@²@A“@@Ö@@Ų@@Ś@@Ü@@Ž@@ą@Aā@@ @@ @@ @A @@8 @@: @@< @@> @@@ @@B @AD @@v @@x @Az @@‚ @@„ @A† @@– @@˜ @Aš @@¦ @@Ø @@Ŗ @A¬ @@ą @@ā @@ä @@¤ @A¦ @@ą@Aā@@@A@@ @A@@0@A2@@6@@8@@:@@<@@>@@@@@B@@D@@F@@H@@J@@L@AN@@Ś@AÜ@@ž@A@@@A@@*@A,@@0@@2@@4@@6@@8@@:@@<@@>@@@@@B@@D@@F@AH@AJ@@@A@@:@A<@@B@AD@@f@Ah@@l@@n@@p@@r@@t@@v@@x@@z@@|@@~@@€@@‚@A„@@,@A.@@P@AR@@X@AZ@@|@A~@@‚@@„@@†@@ˆ@@Š@@Œ@@Ž@@@@’@@”@@–@@˜@Aš@@2@A4@@V@AX@@^@A`@@‚@A„@@ˆ@@Š@AŒ@@Ŗ@A¬@@Ī@AŠ@@Ö@AŲ@@ś@Aü@@@@@@@@@@@@ @@ @@@@@@@@@@@@@A@@$@@&@@(@@:@@<@@>@@@@@B@@D@@d@@f@@h@@j@@l@@n@@ž@A @@Ŗ@@¬@A®@A¾@ AĄ@@Ź@ @Ņ@@Ō@@Ö@@Ų@@Ś@@Ü@@š@@ü@@ž@@ @@ @@ @@ @@6 @@8 @@: @@< @@> @@@ @@B @@D @@X @@d @@f @@h @@j @@l @@n @@ž @@  @@¢ @@¤ @@¦ @@n!@@ę!@Aø&@ @&'@@('@@ˆ4@@Ž3@A@4@AjPA\4@AlP@‚4@@nP@ˆ4@GTimes New Roman5€Symbol3& Arial5OptaneCFComic Sans MS;€Wingdings"qˆŠh±³%¦€ŗ&F­³%¦, ƒ&1"„Ą““€245V ’’#Hazardous Materials Property SurveyChristine Conway Miss Pixel?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?x?ģ„ĮG æEbjbjŽŁŽŁ Rģ³ģ³ļH’’’’’’]4444444hppphŲō|hģ4lx” """"“Öd:4)))))))$X6ōL8¤:)² 4n""nn:)44""Œģn^4"4")hh4444n)Žä&Žœ(h44)"p`ł|Ȟ½hpĢ:)Root Entry’’’’’’’’ ĄF B;Ė…½`ł|Ȟ½z€Data ’’’’’’’’)1Table’’’’1UWordDocument’’’’sR’’’’’’’’  !"#$%T’’’’’’’’’’’’*+,-./0ž’’’23456789:;ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ž’’’USWXYZ[\]^_`abcdefghijklmnopqrž’’’twż’’’ž’’’ž’’’{yž’’’’’’’’’’’’’’’’’’’SummaryInformation(’’’’’’’’’’’’ ČDocumentSummaryInformation8’’’’’’’’ōKJ†šš CompObj’’’’’’’’’’’’=  SJTĒJj SJ0Tableż  SJL’’’’’Õ;BŻ  SJ’’’’’’’’’’’’½ TĒJÄJJVš8ž’’’ ž’’’ ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ _PID_GUIDäAN{43FC3251-4AC1-11D1-883A-3C8B00C10000}ž’ą…ŸņłOh«‘+'³Ł0˜˜ÄŠģų  , H T ` lx€ˆä$Hazardous Materials Property SurveyazaChristine Conwayls hri Normal.doto Miss Pixelo3ssMicrosoft Word 8.0 @Œ†Gž’ ’’’’ ĄFMicrosoft Word Document MSWordDocWord.Document.8ō9²qž’ÕĶ՜.“—+,ł®DÕĶ՜.“—+,ł®X hp„Œ”œ ¤¬“¼ Ä ōä elf, inc. & 5³  $Hazardous Materials Property Survey Title˜ 6>@VŽŽŹ…½@n›mĖ…½@ha[Ȟ½,žŸ ”¢»¼½ĮĀĆĖĢĶÓŌÕÖpqrŅÓpq‚ƒ†‡˜™›œžŸ ”¢£¤„¦§mn€ƒ„•–˜™š›œžŸ ”¢£¤„  !"346789:;<=>?@AB(),->?ABCDEFGHIJKLM™š«¬Æ°ĮĀÄÅĘU V g h k l } ~ €  ‚ ƒ „ … † ‡ ˆ ‰ Š ‹ Œ Ž ’ “ ”  ž Ÿ   ” ¢ ² ³ “ µ ¶ · Ļ Š Õ Ö × ß ą å é ź ė ģ ķ ī ų ž ’         ! " , 2 3 4 5 6 7 O P Q R S · ó \“”īļ -.345678@@@†@Aˆ@@Ø@@Ŗ@@¬@@®@@°@@²@A“@@Ö@@Ų@@Ś@@Ü@@Ž@@ą@Aā@@ @@ @@ @A @@8 @@: @@< @@> @@@ @@B @AD @@v @@x @Az @@‚ @@„ @A† @@– @@˜ @Aš @@¦ @@Ø @@Ŗ @A¬ @@ą @@ā @@ä @@¤ @A¦ @@ą@Aā@@@A@@ @A@@0@A2@@6@@8@@:@@<@@>@@@@@B@@D@@F@@H@@J@@L@AN@@Ś@AÜ@@ž@A@@@A@@*@A,@@0@@2@@4@@6@@8@@:@@<@@>@@@@@B@@D@@F@AH@AJ@@@A@@:@A<@@B@AD@@f@Ah@@l@@n@@p@@r@@t@@v@@x@@z@@|@@~@@€@@‚@A„@@,@A.@@P@AR@@X@AZ@@|@A~@@‚@@„@@†@@ˆ@@Š@@Œ@@Ž@@@@’@@”@@–@@˜@Aš@@2@A4@@V@AX@@^@A`@@‚@A„@@ˆ@@Š@AŒ@@Ŗ@A¬@@Ī@AŠ@@Ö@AŲ@@ś@Aü@@@@@@@@@@@@ @@ @@@@@@@@@@@@@A@@$@@&@@(@@:@@<@@>@@@@@B@@D@@d@@f@@h@@j@@l@@n@@ž@A @@Ŗ@@¬@A®@A¾@ AĄ@@Ź@ @Ņ@@Ō@@Ö@@Ų@@Ś@@Ü@@š@@ü@@ž@@ @@ @@ @@ @@6 @@8 @@: @@< @@> @@@ @@B @@D @@X @@d @@f @@h @@j @@l @@n @@ž @@  @@¢ @@¤ @@¦ @@n!@@ę!@Aø&@ @&'@@('@@ˆ4@@Ž3@A@4@ ARA\4@ AlP @‚4@ @„4@@R@ˆ4@GTimes New Roman5€Symbol3& Arial5OptaneCFComic Sans MS;€Wingdings"1ˆŠh±³%¦öņ)f­³%¦, ƒ&Į"„Ą““€45V ’’#Hazardous Materials Property SurveyChristine ConwayChristine Conwayng at this address must complete a separate Income Status Worksheet. If the other families have not yet completed their own worksheet, inform the POC.Name the head of household for each family that lives at this address: Complete the following information for your family only.Size of householdType oģ„ĮG ,æEbjbjŽŁŽŁ Tģ³ģ³ļH’’’’’’]U4‰‰‰‰‰4½Å(Å(Å(h-)I)|½²JlĶ1”a2w2w2w2w2“+3d34Ē>É>É>É>É>É>É>$LōN°ķ>Å ‰Ć3w2w2Ć3Ć3ķ>‘4‰‰w2w2į)ģ‘4‘4‘4Ć3|‰w2‰w2Ē>½½‰‰‰‰Ć3Ē>‘4‘4—<ŽO>h‰‰Ē>w2Å)ąea‹Šģ½½Å(?4R·>‚ƒž’’’…ż’’’‹ż’’’ŠŒž’’’ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’Root Entry’’’’’’’’ ĄF B;Ė…½ąea‹Šģ½‰€Data ’’’’’’’’)1Table’’’’1ĀNWordDocument’’’’„T’’’’’’’’  !"#$%&'(<*+,-./0ž’’’23456789:=’’’’ž’’’>?@ABCDEFGHIJKLMNOPQR|’’’’’’’’’’’’WXYZ[\]^_`abcdefghijklmnopqrž’’’’’’’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’’’}~€ž’ ’’’’ ĄFMicrosoft Word Document MSWordDocWord.Document.8ō9²qž’ÕĶ՜.“—+,ł®DÕĶ՜.“—+,ł®X hp„Œ”œ ¤¬“¼ Ä ōä elf, inc. & 5³  $Hazardous Materials Property Survey Title˜ 6> _PID_GUIDäAN{43FC3251-4AC1-11D1-883A-3C8B00C10000}ž’ą…ŸņłOh«‘+'³Ł0 ˜ÄŠģų  (4 P \ h t€ˆ˜ä$Hazardous Materials Property SurveyazaChristine Conwayls hri Normal.dotoChristine Conwayls 4riMicrosoft Word 8.0 SummaryInformation(’’’’’’’’’’’’ ŠDocumentSummaryInformation8’’’’’’’’ōKJ†šš CompObj’’’’’’’’’’’’=  SJTĒJj SJ0Tableż  SJL’’’’’Õ;BŻ  SJ’’’’’’’’’’’’½ TĒJÄJJVš8@ŅIk@A¹±…½@6NH²…½@œī‰Šģ½,