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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP., AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> 1. Date you acquired property 7 b �(� <br /> APN: D0 ` `3SJ Co. <br /> ` 2.Use of property since acquisition <br /> 3.How many irrigation wells serve the property: Depth of well(s) if <br /> known <br /> 4. Do you have a permit to apply chemicals or fertilizers to the parcel?If yes, for what years A44! <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 an other <br /> substance considered a controlled substance by Local/State/Federal Law. Yes No ✓ (if yes, <br /> please explain. <br /> B. Existing cistern,hand dug well or leach field,no longer in use.Yes No . ✓ (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 No 1✓ <br /> _ D. Flooding of parcel in part,or whole. Yes No ✓ If yes,w t years <br /> E.Contamination of air or soil from adjacent parcels Yes No <br /> F. Failed septic system,that required repair or additional work. Yes—No 1/If yes describe work <br /> done <br /> G. A prior/present condition that may preclude developement of the parc5pl(s). Yes No <br /> H. A specific location where equipment was/is fueled. Yes NoDo✓ you know what use was <br /> 6.Name of former owner �^ %� + �e rv� e s' <br /> made of the land by the owner? If so, please descnbe <2 ,3 f-n Dcz�S <br /> 7. Has the land been deep ripped since owned by you?Yes No ✓ <br /> 8.Are you aware of any perched water table/springs or on occasion pools of water on site?Yes No 1! <br /> Comments: <br /> _ <br /> ( er/Rep. Signa ) Date <br /> A�o <br />