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U7/YO/2009 15:11 FrLY 763 7R6 9065 BLAII9E STATE BANK (�JOQ2/005 ' <br /> I <br /> ��rl�o� <br /> PItOF�S510IVl�l SE3tVICES <br /> ASTM PRACTICE E i5z�-o5 USER/CLIEI�IT QtTESTIONNAIRE <br /> To be returned to Carlson Professional Services, Inc (Carlson)in accordance wiih <br /> the Scope of Work agreed ta complete this project. <br /> Providing the following information (if available) to the envirorunental professional <br /> (Carlson) is one of the requirements to quality for pne of the Iandowner Lrabilrty ' <br /> Protec�iorrs (I.LPs) offered by Comprehensive Environxnental Response, <br /> Compensation and LiabilityAct(CERCL.A) (qz U.S.C. §96oi). Failure to provide this <br /> information could result in a determination that "all appropriate inqczir�' is not ' <br /> complete. , <br /> Gener�,l Information• ' <br /> User/Client <br /> Names(s):__���T�� ���~��'�- /`���/� <br /> Property Name and .S�,.L� T� t ��� � � �` f�' - <br /> Address: , _ o nj� ���`(�j <br /> Property Type ' <br /> (commer a 1, residential ��������� <br /> etc;: ,--�_ ���,�L """ 5���L� ��1�.-`� i L ' . <br /> Type of Property � ,1 <br /> Transaction: I c5 r Q�i'�Y��i e. (�"�� ���� G'� �u����'' ' <br /> -:-�T� �� <br /> Reason Ph�ise ' � ' <br /> y�Re uired: �iU�-Q3nf ���L.� l�M " J ;�j� � ����`'" ' <br /> G��C1.i.17.�.ir.v'd I E'Q�'Is��/�i�U. ' <br /> Site Contact(s):�� a� ���j������ <br /> Identify Additional Parties <br /> who may R�ely o his <br /> Phase I: _ /.O�G� . � '� �(' C.��/61 .��d <br /> Zds Apolfo Drive,Sui[e!00 •Lino l,�kes,MN 55014 Page 1 ojQ <br /> Phone 763-489-790D •F'ar 763-489-7959 • <br /> �E'C1c-'�"" _ <br />