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Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: E07025A <br /> Property Location: 21301 N. Rond Rd <br /> Page 11 of 11 <br /> 2. Have pesticides, herbicides or other agricultural chemicals been mixed, ( Yes ❑ No <br /> formulated, rinsed, or disposed of on the property? If so, please <br /> describe the locations where such pesticides, herbicides or chemicals <br /> were mixed, formulated, rinsed, or disposed, and the type of <br /> pesticides, herbicides or chemicals mixed, formulated, rinsed or <br /> disposed of at each location. <br /> l (� �°�i�f C fG{�s �1' �e�,/��G Ol>✓5 �GL�I� bep—YL <br /> ,� porfub/L a fvJfy Cnc/Ds� <br /> 3. Has any soil or groundwater analysis been performed to detect ❑ Yes �No <br /> pesticides, herbicides or chemicals used at the site? If so, please <br /> provide a summary of the findings or attach the report(s). <br /> ENDORSEMENTS: <br /> Part 2 <br /> As the present owner of the property or as an officer or general partner of the present owner of the <br /> property (or the duty authorized representative of such owner), I am familiar with all of the operations <br /> presently conducted on the property, and hereby certify that to the best of my knowledge, <br /> information, and belief the information disclosed above is true and correct. <br /> ,Owrrer or Site Manager's Signature Date <br /> T6-7F1r-kcy G_ �Z- L`�A) <br /> Owner or Key Site Manager's Name (please print) <br /> Title, Company <br /> If you have any questions about this questionnaire,please contact Tina Cheney at(209)367-3701 ext. 233. v <br />