Appendix D Questionnaire from Simeon0CORNERSTONE
C0 EARTH GROUP
General Environmental Questionnaire
Cornerstone Earth Group is performing a Phase I environmental site assessment (ESA). The
purpose of the ESA is to evaluate current and historic uses of the property that may have
involved the use, generation, or storage of hazardous materials. Please respond to these
questions to the best of your knowledge.
Return the completed, signed questionnaire by fax at (408) 245-4620 or by mail to the address
below. Alternatively, a copy can be emailed to sfoster@cornerstoneearth.com. The
completed questionnaire will be attached to the ESA report. Thank you for your assistance and
timely response.
GENERAL PROPERTY INFORMATION
1) Site Address(es) and Assessor's Parcel Number(s): Please list all current and former
addresses. Some sites have multiple addresses; all are needed, even if they are not in current use.
Address(es) APN Number(s)
10333 North Wolfe Road
Cupertino
CA 95014
2) Property Size: 5.16 Sq. Ft. or V Acres
3) Current site owner(s) and purchase date:
Current owner Name
Wolfe Properties, LLC, a Delaware limited liabifity company
4) Previous site owner(s) and dates of ownership:
Prior Owner Name Year Purchased
East West Bank 2010
Year Purchased
2012
Year Sold
2012
1259 Oak Mead Parkway I Sunnyvaie, CA 94085 I T 408 245 4600 I F 468 245 4620 I www.eornerstoneearth_Gom N
C CORNERSTONE1. EARTH GROUP
STRUCTURES AND OCCUPANTS
5) Please describe all on-site buildings:
Building Sizes . ft Building Use
no buildings on site
Date of Construction
Potable Water Source (e.g., city or other water agency, on-site well, etc.): California Water Service
Sewage Disposal System (e.g.. city sewer, septic tank, etc.): Cupertino Sanitary District
Heating/Cooling System and Fuel Source (e.g., electric, natural gas, fuel oil, etc_): PG&E
6) Current site tenant(s), site use, and years of occupancy:
Years of Occupancy
Tenant Site Use 1e.a.. From 1995 to 2007)
Apple Inc Construction Storage 2015 to current
7) Prior site tenant(s), site use, and years of occupancy:
Years of Occupancy
Tenant Site Use (e.a, From 1975 to 1983)
Vallco Mall overflow parking ? to 2012
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EARTH GROUP
OTHER SITE FEATURES AND INFORMATION
8) Please indicate if you are aware of any of the following structures, features, or activities
currentlV or formerly at the site.
Structure/Feature Yes No
Do Not
Know
Aboveground Storage Tanks ASTs
X
Agricultural fields
X
Agricultural or drinking water supply wells
X
Air emission controls stems
X
Areas where garbage or other wastes have been disposed on-site
x
Boilers
x
Chemical mixing or processing activities
X
Chemical story a areas
x
Current or former drainage ditches, ponds, or streams
X
Dry cleaning equipment
x
Dry wells
X
Elevators
x
Emergency enerators
x
Equipment maintenance or repair areas
X
Fill materials placed on-site (i.e., fill used to build up the site elevation
to current level
x
Ground water monitoring wells
X
Ground water or soil remediation systems
X
Hydraulic; lifts
x
Incinerators
X
Manufacturing machinery
x
Medical Waste
X
Oil or gas wells
x
Petroleum pipelines
X
Railroad lines
x
Septic tanks
x
Stockpiles of soil or debris
x
Storage sheds
x
Sumps, clarifiers, oillwater separators, or similar structures
X
Transformers
x
Underground Storage tanks USTs
X
Vapor or dust control hoods and ducting
X
Waste burning areas i.e. burnpit) or ash disposal area
x
If you checked yes to any of the alcove, please provide additional information here or attach to
this questionnaire.
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9) Please indicate if, to your knowledge, any of the following documents exist:
Document
Do Not
Yes No Know
Environmental site assessments
X
Environmental permits or violation notices
X
Underground or above ground storage tank documents/permits
X
Geotechnical reports or h dro eolo is studies
X
Risk assessments
X
Hazardous materials mann ement plans or chemical inventories
X
Safetylemergency response plans ors ill prevention plans
X
Compliance audits or community right -to -know plans
X
Asbestos or lead based paint surveys
X
If you checked yes to any of the above, please indicate the location of the documents.
Can copies be provided? Yes No X
10) Have significant quantities of hazardous materials been used, stored, or generated on-site?
Yes No X
If so, please list types and quantities and where these materials are or were located.
11) Are you aware of commonly known or reasonably ascertainable information about the site
that would help the environmental professional to identify conditions indicative of releases
or threatened releases? For example, do you know of past uses of the site, specific chemicals
that were or are present at the site, have knowledge of spills or other chemical releases at the site,
or any environmental cleanups at the site.
Yes No X
If so, please briefly describe below, including whether reports documenting the activities are
available for review by Cornerstone Earth Croup.
12) Are you aware of any environmental cleanup liens against the site that are filed or recorded
under federal, tribal, state, or local law?
Yes No X
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13) Are you aware of any activity or use limitations (UALs), such as engineering controls, land
use restrictions, or institutional controls that are in place at the site and/or have been filed
or recorded in a registry under federal, tribal, state, or local law?
Yes No x
If so, please briefly describe below.
14) Are you aware of 1) any pending, threatened or past litigation, or administrative proceedings
relevant to hazardous substances or petroleum products at the site, or 2) any notices from
any governmental entity regarding possible violations of environmental laws or possible
liability related to hazardous substances or petroleum products?
Yes No x
If so, please briefly describe below.
15) Completed by:
Mike Kim
SIME=ON 217118
Name (print) Signature Company Date
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