Environmental Questionnaire and Disclosure Statement

The purpose of this questionnaire is to provide information upon which ATB will rely as a factor in deciding whether or not to extend credit. Please respond to all questions. If unable to answer, please respond “unknown” if you do not have the applicable information to answer or “not applicable” if the question is not applicable to the business or property. Where space is inadequate to answer, please attach additional pages as needed.

THE BUSINESS
Legal Name:
Municipal Address:
In order to operate your business, do you need to be granted a license under any environmental act or regulation, i.e. clean air, clean water, environmental protection, etc.?

If yes, are you subject to any regular inspection or re-licensing requirement?

If yes, how often do these occur, when was the last inspection, and what was the result of this inspection?
In the past three years, has there been a spill, contamination, discharge or emissions on the occupied premises that would be reportable under your current licensing requirement?

If yes, please describe the nature of the incident, the corrective action taken, and the response from the relative regulatory body?
Have there been, or are there any existing, pending, or threatened actions, including control or stop orders, or litigation involving environmental matters on the occupied premises? If yes, please describe them.
Do you have environmental policies/practices, including an emergency response plan, in place to handle any environmental emergency on any operated property to ensure the continuation of regular business operations? If yes, please describe.
Do you carry environmental liability insurance? If yes, please provide details.

Customer’s Signature
I (undersigned) represent and warrant that, to the best of my knowledge and after due inquiry and investigation, that the information contained herein is true and correct and that I have candidly disclosed to ATB Financial, previously Alberta Treasury Branches (“ATB”) all past and present environmental issues relating to these Lands.

Furthermore, I agree to immediately notify ATB of any future environmental issues involving the Lands as they become known to me.
Type here
Date
Per: Insert name of corporate Customer's signing officer
Date
Insert title of corporate Customer's signing officer
And per: Insert name of corporate Customer's signing officer
Date
Insert title of corporate Customer's signing officer

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Form 3001 (Rev. 01/18)

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Lam, Kara

2019-12-03

Wilson, Michael

ATB Financial