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Sep-27-02 06: 16A MONTE M SEIBEL 209-330 ;523 P_01 <br /> ENVIRONMENTAL QUESTIONAME <br /> TO BE COMPLETED BY OWNMO WNM,S REP.,AND FORWARDED TO EARNEST F. SMfrH <br /> AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SURFACFAUB SURFACE <br /> CONTAMWATION REPORT. <br /> I.Dae you acqu ood propertyI9 49 APN:�OOS- ©� (Q� sJ CO. <br /> 2. Use of property since aCgroeltion ---- <br /> 3.How many imgstion wells serve the Property' Aepth of well(!)if <br /> known— <br /> 4. <br /> 4.Do you have a permit W apply ebesnieals or falilimm to the parcel?If yes,for what yeas p__l v <br /> Describe the products Produced <br /> . 5. Do you have any lmowkdge of any of the following being preum on the Parcel under study? <br /> A.Any disposal site,by former/presort owner,of lull,hazardous materials,chsmicals or any Otho <br /> 9dAfanoe emsider.d•c�nhvlled aubstsxe by I.ocaVSdte/Fadeeal Lw. Yes,r__Nb_�(lf Yes. <br /> pleas!arPW <br /> B.Existing cistern hand dug well or leach Held,no longer in use. Yp No yes <br /> p1cw love on property for the Heid mview which is to be;completed after receipt of this form.) <br /> C_Smucturos stat aro considered madb by you or local authorities. Yd Nom <br /> D.Flooding orpmed in Part,or whole. Yes--.?( No— If y m wlat Yews, �... <br /> E-Conaimoon of air or soil from adjacaa Psfc@b Ya No <br /> F. Failed septic system slat required repair or additional work yes describe work <br /> done — <br /> G.A prior/present condidom that may preclude developemeR%of the Parcel(!).Yes <br /> H.A specific location where etgtupntent ww&AWW. Yes—No. X <br /> . 6.Name of firmer owtsa Do you know what use was <br /> made of the Wel by the owm m,pley�sj r� <br /> ay <br /> 7_Has the:land been dory ripped s //owned' by YTMfl <br /> tt. Are you aware of pry parched.rates tablrlapriJW or on occasion pooh of water an site?Yes—No X <br /> Co r y�in9 //PllV rAhao�r r5 ton ..oe.c� <br /> _fo Cre K <br /> tl;sA.1 rrr �cJD� _ <br /> (Ownes•..Fp.S[ ) Date <br />