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ENVIRONMENTAL QUESTIONAIRE TO BE COMPLETED BY OWNER/OWNEWS REPRESENTATIVE AND FORWARDED TO WALTER E. CURTIS, CIVIL ENGINEER,FOR INCLUSION IN A "SURFACE AND SUBSURFACE CONTANIINATION REPORT". 1. Date you acquired property /9 7G APN: (if known) 2. Use of property since acquisition t A S T 7-IMF- 3. /ME3. How many irrigation wells_�domestic wells_�serve the property? 4. Depth(if known) of irrigation wells 4;,P42 —domestic wells 3 PP 5. Do you have a permit to apply chemicals or fertilizer to the parcel? Yes_No g 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 X (D)Any flooding of parcel in part or whole Yes—No J< If yes what years (E)Any contamination of air or soil from adjacent parcels Yes_No X If yes, identify contamination type (F)A failed septic System, which required repair or additional work Yes_No X If yes describe the work done (G)A prior/present condition that may preclude development of the property Yes_No k If yes, explain (H)A specific location where equipment was/is fueled Yes_No 7. Name of former owner Do you know what use was made of the land by the owner? If so, please describe C47-2`1-,f 8. Has the land been ripped since owned by you Yes_No /lc_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? ^I O T L,t-v rL 14 ----e i = 2-/or Owner/Representative Signature Date