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Client Information Request Form <br />for Phase I Environmental Site Assessments <br />N. Utilities <br />Are there any wells or septic systems formerly or currently located at the Site? <br />Wells: ❑ Yes ❑ No ❑ Unknown <br />Septic systems: ❑ Yes ❑ No ❑ Unknown <br />Is the Site connected to city sewer and water? <br />Sewer: ❑ Yes ❑ No ❑ Unknown <br />Water: ❑ Yes ❑ No ❑ Unknown <br />What types of utilities service the Site? Check all that apply. <br />❑ Unknown <br />❑ Gas <br />❑ Electric <br />❑ Propane <br />❑ Other: <br />O. Are there any environmental concerns regarding the property or adjoining properties? <br />P. How are the adjacent properties used? <br />Revised 05/29/2018 Page 4 of 4 <br />