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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REF., AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CPAL ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> 1. Date you acquired property_!2. %0 APN: 007 -3)0 — k SJ Co. <br /> 2. Use of property since acquisition <br /> 3. How many irrigation wells serve the property: Depth of well(s)if <br /> known /V 400 <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?If yes, for what years h/O <br /> Describe the products produced <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 /> substance considered a controlled substance by Local/State/Federal Law. Yes_No__X (If yes, <br /> please explain. <br /> B. Existing cistern, hand dug well or leach field,no longer in use. Yes—No----2L—(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 X No <br /> D. Flooding of parcel in part, or whole. Yes No_�_If yes, what years <br /> E.Contamination of air or soil from adjacent parcels Yes No x <br /> F.Failed septic system,that required repair or additional work.Yes No_Y If yes describe work <br /> done N) 5 f;P'i 1 C 9y5i Es^ <br /> G. A prior/present condition that may preclude developement of the parcel(s). Yes No--)�_ <br /> H. A specific location where equipment was/is fueled. Yes Nom_ <br /> Do you know what use was <br /> 6.Name of former owner <br /> made of the land by the owned If so, please describe <br /> 7. Has the land been deep ripped since owned by you?Yes--No--x— <br /> S. <br /> esNo--x_8. Are you aware of any perched water table/springs or on occasion pools of water on site? Yes_No4 <br /> Comments: <br /> 200 S <br /> (Owner/Rep. Signature) Q Date <br />