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<br />Attachment 3 <br /> <br />c.s <br /> <br />Ll':VI!:L II SURVEY <br />CONTAMINANT SURVEY OF PROPOS&O <br />REAL ESTATE ACQUISITIONS <br />BUREAU OF RECLAMATION <br /> <br />A. Background Information. <br />Project <br />Pro1>l'rty IO <br />Owner <br />Date of survey <br />Photographs of site taken? Yes No <br /> <br />County <br /> <br />State_ <br /> <br />Available from: <br /> <br />B. Identify and restate statements on the checklist which had answers other <br />than MNo," "None," or "Not applicable" (attach continuation aheets if needed). <br /> <br />C. Describe the results of the investigation for the real estate covered in <br />this B~rvey. The pr~ary focus should be on the detection of or presence of a <br />contaminant. Document whether current budgets will be used or if <br />reprogramming will be necessary. Provide an estimated cost of any <br />removal/remedial activity anticipated. Include estimated cost of preparing <br />this survey, including the coats of studies and investigations, if they are <br />necessary (attach continuation sheets if needed). <br /> <br />D. Certification (CHECK ONE and use appropriate signature page). <br /> <br />1. "I certify that to tne best of my knowledge contaminants, or <br />the effects of contaminants, are not present on this real <br />estate.- Acquisition of an interest in this real estate is <br />recommended. (Use signature page A and provide copy of survey <br />to 0-5620. I <br /> <br />1 <br />