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MAY-15-2006 15:29 FROM:CaOLD COAST WIRELESS 2093391441 TO:3694228 - P.3 <br /> MON MAY 15, 2006 03:24 PM <br /> ` Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: E06058A <br /> Property Location: 11351 E. Jahant Road,Acampo CA 45220 <br /> Page 5 <br /> NEIL O. ANDERSON ft ASSOCIATES, INC. <br /> _ ENVIROMENTAL QUESTIONNAIRE AND DISCLOSURE STATEMENT <br /> PART 2: OWNER INFORMATION <br /> (To be completed by Owner or Owner's representative) <br /> I GENERAL INFORMATION <br /> 1. Current owner of property <br /> .. Name: $7v-.'e-t a I- . 5 TO <br /> Address: 11351 E <br /> Telephone: lfn <br /> �i��CO 3G8 -S 76 <br /> Year purchased: C)C)a- <br /> 2. Previous owner(s)and contact information (if known): <br /> �- Name: <br /> Address: - <br /> '� Telephone: <br /> Year purchased: <br /> 3. Other person with historical knowledge of property: <br /> Name: <br /> Address: <br /> Telephone: <br /> Relationship to property: <br /> 4. Please describe current use(s)of property: <br /> 5. Please describe any other known past use(s)of property,and approximate dates of each use: <br /> GP'C)1?5 <br /> IJ rrou Gmr mrr gneniom above this guenrmmahe.please comwi lista Clreeev a f200 367-3701 erg.233. <br /> V <br /> r J/ <br />