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M ENVIRONMENTAL QUESTIONNAIRE <br /> � Fa <br /> TO BE COMPLETED BY OWNER/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMI'T'H <br /> AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> k <br /> ' 1.Date you acquired Propertyof APN: t 1 f3 3 7 SJ Co. <br /> 2. Use of property since acquisitions <br /> i <br /> 3.How many irrigation wells serve the=prnperty .r = Depth of well(s)if <br /> i known_jgaL�L. t j 61�1 <br /> 4. Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years <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 140 V (If yes, <br /> please explain. <br /> B.Existing cistern,hand dug well or leach field,no longer in use. Yes ----yo�" (If yes <br /> please locate on property for the field review which is to be completed after receipt of this form.) <br /> C. Structures that are considered unsafe by you or local authorities. Yes-No r <br /> D.Flooding of parcel in part,or whole. Yes No��If yes,what y ' <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 <br /> G.A prior/present condition that may preclude developement of the parcel(s). Yes No_,�e ^ <br /> H. A specific location where equipment was as fueled. -es No <br /> 5.Name of former owner '' Do you know what use was <br /> made of the land by the owner?If so,please describe <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 ois of water on site?YesNo�l <br /> Comments: <br /> r <br /> ! (Owner/Rep. Signature) Date <br /> �J <br />