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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COLLETED 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 �"/' APN: %-3 3ZD S s� SJ Co. <br /> 2. Use of property since acquisition <br /> 3.How man irrigation wells serve the property: ��- Depth of well(s)if <br /> known yy� ; <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years /l'c? <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 (If yes <br /> please locate on property for the field review which is to be completed ager receipt of this form.) <br /> C. Str,rcture<s that ane considered unsafe by you or local audic rkics. Yes No ,x <br /> D. Flooding of parcel in pant,or whole. Yes NoIf yes,what years <br /> E. Contamination of air or soil firm adjacent parcels Yes No x <br /> F.Failed septic system,that required repair or additional work.Yes No )e�If yes describe work <br /> dome <br /> G.A prior/present condition that may preclude developerrrent ofthe parcel(s).Yes No <br /> H. A specific location where eqt iw�erit walls fuelg&Yes No <br /> 6.Name of former owner you know what use was <br /> made of the land by the owner?If so,please describe _ <br /> 7.Has the land been deep rippod since owned by you?Yes No >c <br /> 8. Are you aware of any perched water table/spnngs or on occasion pools of water on site?Yes Nom_ <br /> Comments: <br /> (Owner/Rep. Signa m) Dafiee <br /> 13 <br />