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Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: E07025A <br /> Property Location: 21301 N. Rond Rd <br /> Page 5 of 11 <br /> NEIL 0. ANDERSON Et ASSOCIATES, INC. <br /> ENVIROMENTAL QUESTIONNAIRE AND DISCLOSURE STATEMENT <br /> PART 2: OWNER INFORMATION <br /> (To be completed by Owner or Owner's representative) <br /> 1. GENERAL INFORMATION <br /> 1. Current owner of property <br /> Name: rL�Ct�� C3. f� e Y� �LkVl l / <br /> Address: p 9 box ! qZ ( c,-7 5'f 0"�-fv h <br /> Telephone: 2.4 C' (7556 - V`W <br /> Year purchased: /? / J a vA 1A.6.�r <br /> 2. Previous owner(s) and contact information (if known): <br /> Name: At Lq T)6 AAJ o `. C • I�A b <br /> Address: , <br /> Telephone: <br /> Year purchased: 7 <br /> 3. Other person with historical knowledge of property: <br /> Name: G(2 Vl i 5 ( -6,5 eA <br /> LL -71/71-/ 614 ILO 6-11A- <br /> Telephone: <br /> � 9 S2� <br /> Address: U <br /> �� �k <br /> Telephone: 79y qo .-�? - g !7c)o l <br /> Relationship to property: &Ckiw,a f rq <br /> 4. Please describe current use(s) of property: <br /> h9r;c LA NuJc— ( Fa�r �'vN-ol <br /> 5. Please describe any other known past use(s) of property, and approximate dates of each use: <br /> Ijyou have any questions about this questionnaire,please contact Tina Cheney at(209)367-3701 ext. 233. <br />