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• • • • • ENVIRONMENTAL QUESTIONNAIRE • • TO BE COMPLETED BY OWNEWWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH • AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SURFACEISUB SURFACE • CONTAMAIATION REPORT. • 1. Date you acquired property 340 — 68 SJ Co. • 2.Use of property since acquisition A/07— 00e • • • 3.How many irrigation wells serve the property: Drptlt ofwell(s)if • known • 4_Do you have a permit to apply chemicals or fertilizers to the parcel?Ifyes,for what years�� G • Describe the products produced • 5.Do you have any knowledge of any of the following being present on the parcel under study? • A.Any disposal site,by fonner4xesent 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 cistem,hand dug well or leach field,no longer in use.Yes No (If yes • please locate 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 • D.Flooding of parcel in part,or whole. Yes No ->� If es,what years • E.Contamination of air or soil firm adjacent parcels Yes No • F.Failed septic system,that required repair or additional work.Yes No If yes describe work done /, c� ✓�cTYKL /�r'cc�— /f� T1q rLC' • G.A prior/present condition that may preclude devdapancot of pamel(s).Yes No • H_A specific location where equgxnent vraMs fueled.Yes No� 6.Name of former owner /C ;s ,, Do you know what use was • made of the land by the owner?If so,please describe_ q,4� rc4 va 7`i uvj • • 7. Has the land been deep ripped since owned by you?Yes No 8.Are you aware of any perched water tabletsprings or on occasion pools of water on site?Yes No X • • Comments: • • • • • � � Y�y lv • rner p.Signatpfe Dib • • • • •