CLEAR

WELLS FARGO SBA ENVIRONMENTAL QUESTIONNAIRE (EQ)

The EQ must be completed in full to the best of the property owner’s knowledge. An incomplete EQ will affect the ability to
qualify for a RSRA.
For the purpose of this EQ, adjoining properties include contiguous properties and properties separated by a roadway.

.[Note: Click on input fields to begin editing for ease in use when completing electronic version of this form.]
APPLICANT
Applicant Name: !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Phone No.:

Is the Applicant the Current Owner of the property? Yes No Email:

How long you have been familiar with or associated with the property?
“SITE” PROPERTY (Include FULL Address)
Address:
Acreage of Collateral: Tax parcel/Assessor’s parcel number(s):

Nearest Intersection/Cross Street(s):

NAICS Industry Code(s) – Mandatory for all SBA loans (must be six digits) NAICS&Code&Link

Current NAICS: All Prior NAICS: !!!!!!!!!!!!!!!!!!!!!!!!!

SITE AND ADJOINING PROPERTY USES/POTENTIAL SOURCES OF CONTAMINATION
1. Provide a detailed description of all current Site and adjoining property uses/occupants, including business names, activities, and dates of
occupancy, with particular emphasis on those uses by environmentally sensitive industries:
Site:

North:

East:

South:

West:

2. Provide a detailed description of all past / historical site and adjoining property uses/occupants, including business names, activities, and dates
of occupancy, with particular emphasis on those uses by environmentally sensitive industries:
Site:

North:

East:

South:

West:

3. What are the construction dates of all buildings present on the Site?

4. What is the potable/drinking water source for the Site?

If Public Water, year connected?
Public Water On-site Well None
5. What is the sewage disposal method?
If Public Sewer, year connected?
Public Sewer On-site Septic None
6. Site Modifications and Improvements:
A. Is any new construction planned? Yes No B. Is redevelopment or renovation planned? Yes No
C. Is demolition planned? Yes No
If yes to any of the above, description must be provided:

SBA EQ Form Version: Revised 8/30/2016 SBA9985 (Rev00 – 09/16) Page 1 of 3

 7. Do any prior environmental report(s) or risk studies exist for the Site?
If yes, report(s) must be provided (if unobtainable, explanation must be provided).
Yes No
8. Are there any Environmental Liens, Environmental Deed Restrictions, Land Use Restrictions, or Engineering Controls associated with the Site?
If yes, please describe in detail:
Yes No
9. For the Site and adjoining properties, do current or past operations include industrial use, gasoline station, motor repair facility, commercial
printing facility, dry cleaners, photo developing laboratory, junkyard or landfill, or as a waste treatment, storage, disposal, processing, or
recycling facility?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
10. For the Site and adjoining properties, are there any current or past regulatory actions (violations, citations, reportable releases or spills, etc.) by
any government entity for environmental conditions, or has the Site or any adjoining property ever been deemed contaminated or included on any
government lists of contaminated sites?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
11. Are there past, threatened or pending lawsuits or administrative proceedings concerning a release or threatened release of hazardous
substances at the Site or adjoining properties?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
12. Are there currently, or have there been previously any hazardous wastes generated, stored, treated, emitted, or disposed of on the Site or
adjoining properties?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
13. Are there currently, or have there been previously any businesses operating at the Site or adjoining properties in possession of permit(s) to use,
store, generate, treat, emit or dispose of hazardous substances or petroleum products?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
14. Are there any current or past underground storage tanks (USTs) or above-ground storage tanks (ASTs) that contain(ed) hazardous substances or
petroleum products at the Site? (Attach additional sheet if necessary)
If yes, description must be provided:
Yes No
Year Status (e.g., active, filled-in place, Capacity Product Secondary Containment
UST/AST
Installed no longer used, empty) (gallons) (e.g., gasoline, diesel, heating oil) (Yes or No)
!!!!!! !!!!! !!!!!!!!!!! !!!!! !!!!!!!!!!!!! !!!!!!!!!!!
!!!!! !!!!! !!!!!!!!!!! !!!!! !!!!!!!!!!!!! !!!!!!!!!!!
!!!!! !!!!! !!!!!!!!!!! !!!!! !!!!!!!!!!!!! !!!!!!!!!!!
15. Are there any current or past underground storage tanks (USTs) or above-ground storage tanks (ASTs) that contain(ed) hazardous substances or
petroleum products at the adjoining properties?
If yes, description must be provided:
Yes No
16. Are there currently, or have there been previously any vent pipes, fill pipes, or access ways indicating a fill pipe protruding from the ground at the
Site or adjoining properties?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
17. Are there currently, or have there been previously any damaged or discarded automotive or industrial batteries, pesticides, paints, or other
chemicals, hazardous substances, or petroleum products in individual containers of >5 gallons in volume or 50 gallons in the aggregate, stored
on, produced on, or used at the Site or adjoining properties?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
18. Are there currently, or have there been previously any chemicals in industrial drums or sacks stored on or used at the property or at the Site or
adjoining properties?
Site: If yes, please describe in detail:
Yes No
Adjoining If yes, please describe in detail:
Property(s):
Yes No
SBA EQ Form Version: Revised 8/30/2016 SBA9985 (Rev00 – 09/16) Page 2 of 3