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I,, r <br /> 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 q( APN: 0©7-31W' Z / SJ CO- <br /> 2. Use of property since acquisition k eP b `1 rS <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 11 Ei <br /> Describe the products produced Non P <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 ory other <br /> substance considered a controlled substance by Local/State/Fedemi Law. Yes No V (If yes, <br /> please explain. N/A <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 foryt.) <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 V"' If yehat 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 If yes describe work <br /> done N <br /> G. A prior/present condition that may preclude developement of theparcel(s). Yes No <br /> H. A specific location where equipment was/is fueled. Yes—NO <br /> 6.Name of former owner M r P&A-474- Do you know what use was <br /> made of the land by the owner?If so,please describe_Kp4- I i u p c-r,c-.k <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 Noez, <br /> Comments: <br /> A43 o y <br /> (Owner/Rep. Signature) Date / <br />