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USDA - Natural Resources Conservation Services Landowner Hazmat Interview <br />1 <br /> <br />HAZARDOUS MATERIALS LANDOWNER INTERVIEW <br /> <br />A. Property Information <br />NRCS PROGRAM LANDOWNER NAME <br /> <br /> <br />PROPERTY ADDRESS <br /> <br />NUMBER OF ACRES <br /> <br /> <br />NEST APPLICATION NUMBER COUNTY STATE <br /> <br />Interview Information <br />INTERVIEWER NAME INTERVIEW DATE <br />INTERVIEWEE NAME INTERVIEWEE PHONE NO. <br /> <br />AFFILIATION WITH PROPERTY (e.g., Owner, Operator, <br />Caretaker, Previous Owner, Tenant, Neighbor) <br />TIME FRAME OF AFFILITION <br />(YRs & MOs) <br /> <br />“To the Best of Your Knowledge…” <br />A. Property Uses <br />1. Do you have or know of the existence of any of the following <br />records related to the property? (If yes, please provide copies or <br />make them available.) <br />Yes No Copy <br />Attached No Copy <br />Available <br />a. Radon, asbestos, or lead-based paint surveys <br />b. Environmental compliance audit reports <br />c. Environmental permits related to current or previous site activities <br />(e.g., waste disposal permits, wastewater permits, NPDES permits) <br /> <br />d. Registrations for underground and above-ground storage tanks. <br />e. Hazardous materials management plans (Emergency Planning and <br />Community Right-To-Know Act (EPCRA)) <br /> <br />f. Facility safety plans <br />g. Preparedness and prevention plans <br />h. Spill prevention, control, and countermeasure (SPCC) plans <br />i. Hydrogeologic and geotechnical reports on the property or <br />surrounding area <br /> <br />j. Notices or other correspondence from any government agency <br />relating to past or current violations of environmental laws with <br />respect to the property <br /> <br />k. Notices or other correspondence from any government agency <br />relating to environmental liens encumbering the property <br /> <br />l. Hazardous waste generator notices or reports <br />m. Risk assessments <br />n. Recorded deed or environmental land use restrictions <br />o. Other environmental studies or investigations <br /> <br />DocuSign Envelope ID: 480AFBD4-654C-48FA-9CB8-F7C8D7E98DB2