Laserfiche WebLink
v rl <br /> SUPPLEMENTAL QUESTIONNAIRE FOR AGRICULTURAL SITES <br /> MOUNTAIN HOUSE NEIGHBORHOODS <br /> What is your relationship to the property? Owner ❑ Occupant <br /> ❑ Grower ❑ Other <br /> How long? ,/a-- <br /> Is the property currently used for any agricultural Yes No Unk <br /> use? <br /> What type of crop? <br /> let 3� <br /> Are there any pesticides currently being used on the Yes No Unk <br /> property? <br /> � pa <br /> If yes,please list what types: �P_e �9 c w(D WQZ rr� o <br /> Do you observe evidence or have any prior �5es No Unk <br /> knowledge that pesticides were used on the <br /> property? <br /> Please Describe: <br /> Are any adjoining properties being used for an LYeNo Unk <br /> } agricultural use? ......... <br /> —� <br /> If so, please indicate which oner- Korth South M -- East ^ West <br /> What types? <br /> Are there any pesticides currently being used on any Yes No Unk <br /> adjoining properties? <br /> If so,please indicate which oPeorth South East Wes <br /> If yes,please list what types: "- ""'"`A-•. —___._ ............... <br /> ..�----- <br /> Do you observe evidence or have any priorYes No Unk <br /> knowledge that pesticides have been used on any <br /> adjoining properties? -'�� <br /> If so,please indicate which s- North South East West <br /> Please Describe: <br /> Initials <br /> P:\Mountain House\2496\Supplemental Ag.Checklist.doc <br />