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<br />C5 <br /> <br />E. Has a non-Federal entity identified any hazardous materials problems on or <br />near the surveyed lands? <br /> <br />YES_NO_ <br /> <br />F. A level 11 study is recommended. <br /> <br />YES <br /> <br />NO <br /> <br />A level III study is recommended. <br /> <br />YES <br /> <br />NO <br /> <br />G. Certification ,lCHECK ONE). <br /> <br />I hereby certify that to the best of my knowledge no contaminants <br />are present on this real estate, and there are no obvious signs of <br />any effects of contamination. <br /> <br />On the basis of the information collected to complete this .form, <br />it is possible to reasonably conclude that there is a potential <br />for contaminants, or the effects of contaminants, to be present on <br />that real estate. (CHECK ONE) <br /> <br />Level II or a <br /> <br />Level III survey will be performed. <br /> <br />H. Attach a copy of the required documentation. <br /> <br />PreDared by: <br /> <br />Examiner <br /> <br />Signed <br /> <br />Print Name <br /> <br />Date <br /> <br />Title <br /> <br />Aoorovino Official <br /> <br />I concur with the above recommendation. <br /> <br />Signed <br /> <br />Print Name <br /> <br />Date <br /> <br />Title <br />