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ri <br /> F <br /> ENVIRONMENTAL QUESTIONNAIRE <br /> k <br /> TO BE COMPLETED BY OWNER/OWNER'S REP•,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> F4 CONTAMINATION REPORT. <br /> 1.Date you acquired property—Z---ale- <br /> 2. <br /> roperty _. e--�'�APN: /���'� _SJ Co. <br /> 2.Use of property since acquisition r-6—�' 5 i <br /> 3.How many irrigation wells serve the property: T Depth of well(s)if <br /> known <br /> F -� <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years , -. <br /> Describe thep roducts produced <br /> �S <br /> 5.Do you have any knowledge of any of the following being present on the parcel under study? <br /> A.Any disposal site,by former/present owner,of fuels,hazardous materials'chemicals or any other <br /> F' substance considered a controlled substance by Local/State/Federal Law. Yes Na_-2� (R yes, <br /> please explain. <br /> B.Existing cistern,hand dug well or leach field,no longer in use.Yes No X (If yes <br /> please locate on property for the field review which is to be completed after receipt of this form.) <br /> C.Structures that are considered unsafe by you or local authorities. Yes No X <br /> FD.Flooding of parcel in part,or whole. Yes No X of yes, years <br /> E.Contamination of air or soil from adjacent parcels Yes No— <br /> F. failed septic system,that required repair or additional work Yes No_,,,- yes describe work <br /> Fdone <br /> G. A priodpresent condition that rn$y preclude developement of the l(sl Yes No x <br /> 4 H.A specific location where equipm jj t fueled.Yes No <br /> F6.Name of former owner Ofr-t C �'-� >� ." _Do you know what use was <br /> made of the land by the owner?If so,please describe �� �dee ` <br /> 7.Has the land been deep ripped since owned by you?Yes No <br /> • 8. Are you aware of any perched water table/springs or on occasion pools of water on site?Yes No n <br /> Comments: <br /> (Owner/Rep. Signature) Date <br /> c,�r�rr 33 y -obi <br /> E . <br />