Laserfiche WebLink
v •- ���� lU':44H rKui~I: 2099312373 Tq:3342E11 <br /> P.1/1 <br /> i2 Sos '9►-a.Ntdi- R4 <br /> LC)C ke.fo lad <br /> ENVIRONMENTAL QUESTIONNAIRE <br /> TO RE COMPLETED BY OMM"WNER'S REP.,AND FORWARDED TO EARNP-%7 R SM I"f t <br /> AND ASSOCIATF,%CMI.ENOR03 RS FOR WCLUSM IN SURFACF/SUB SURFACE <br /> CONTAMNATION REP U. <br /> t,batt yew acyoirah P�P�Y_-�.=-:�- APN. �Sl- 3 vZ-o -!b SI Co, <br /> 2. <br /> 11_se crf property since acgniai6an 1LL'_ tC ha e�ti,�lg <br /> 3,.Haw many irrigation Welk serve We Prapaty-_ ! � W-I[ Depth of well(s)if <br /> knnwre <br /> 4-k1O yore have s Paimit to apply chemicals or 6waiaera to the Parcel?Myea,for what years <br /> Describethe prothim ptadnood L la <br /> S.IPO You have mW kwwledgc ofatty aft following being present on the puml under shriy? <br /> A.Any dill site,by hnnff/pmment Owner;affaels'AmBrdous maermb.chornieals or any other <br /> sad»a+miderM a cuauol►ed aubegoee by IAcmUShmwTedm1 Iaw. Ya No,_, _(Ifyes <br /> please explain. <br /> -'W Existing cistern,how dog wen or lead fireld,no loom in use Yes NO & (Ifyes <br /> plea,loco on property for the field review which is to be atmpleted atter receipt of this fora.) <br /> (".Situcamas that are aaidered maafe by you or local authoeilie- Yes NgV_ <br /> D-1Ftoodirtgofp el inpmMorwboke. Yes 1los,- ffyct,whmtyw= <br /> P-Car>mimtionask or salfiomadjatmtpmeb <br /> F-Failed septic system,dist sequined iWar or adrfbmd moria.Yes No 'y-, Ifyes descnbe work <br /> dome <br /> G-Apriodpomr<caadidaogutmayWWu&derdopM=ofIt=parod(s)Yo <br /> H-A specific taction when equipment wasfis faded.Yes�No <br /> 6.Name offenaw awns <br /> . ` 1]o you lrnOPw who use Was <br /> mads of the lmdbythe Ifs*,pleasedmmbe; N-„ <br /> 7-Has the End been --------__ . <br /> deep capped since o+nred by yaR Yt8 No SLC _ <br /> S.Are you swam of erry padwd war or on onmom pools ofwEfim on sine?yes^ No <br /> Comments: <br /> (OtvnedRep 3igrmltr e) nate <br />