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ENVIRONMENTAL OUESTIONAIRE TO BE COMPLETED BY OWNER/OWNER'S REPRESENTATIVE AND FORWARDED TO WALTER E. CURTIS,CIVIL ENGINEER,FOR INCLUSION IN A "SURFACE AND SUBSURFACE CONTAMINATION REPORT". 1. Date you acquired property APN: (if known) 2. Use of property since acquisition 3. How many irrigation wells " domestic wells e!::>_serve the property? 4. Depth(if known)of irrigation wells -61, domestic wells 5. Do you have a permit to apply chemicals or fertilizer to the parcel? Yes_No,K If yes, for what years Name the products used 6. Do you have knowledge of the following being present on the parcel under study? (A)Any disposal site,by former/present owner, of fuels, hazardous materials, chemicals or any other substance considered a controlled substance by Local/State/ Federal Law? Yes_No,,�(__If yes please explain (B)Existing cistern, hand dug well or leach field Yes_No�(If yes please locate them on property for the field review, which is to be completed after receipt of this form.) (C) Structures that are considered unsafe by you or local authorities. Yes_No (D)Any flooding of parcel in part or whole Yes_Nox If yes what years (E)Any contamination of air or soil from adjacent parcels Yes_No Lc If yes, identify contamination type (F)A failed septic System, which required repair or additional work Yes_No a If yes describe the work done (G)A prior/present condition that may preclude development of the property Yes_No -, If yes,explain (H)A specific location where equipment was/is fueled Yes_No�C 7. Name of former owner w�.. i v cC Do you know what use was made of the land by the owner? ff so, please describe ./ o 8. Has the land been ripped since owned by you Yes_No.,X If yes,years 9. If and when the property is irrigated or water flows across it, what is the direction of flow of the water? c/- ownee Representative Signature Date