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SUPPLEMENTAL QUESTIONNAIRE FOR AGRICULTURAL SITES <br /> MOUNTAIN HOUSE NEIGHBORHOODS <br /> Have you leased this land to anyone for agricultural Yes No Unkr <br /> purposes? <br /> If so,please provide contact information: Name: <br /> Firm: <br /> Address: <br /> Phone: <br /> If the type of crop grown on the property was a standing tree,shrub,or bush: N <br /> A. Was it pruned or trimmed annually? Yes No Unk <br /> B. Were the prunings burned on site? Yes No Unk <br /> C. Were the prunings burned in one area? Yes No Unk <br /> D. If yes to A,B,C,then where on site were the trimmings burned? <br /> TA TS y (;o N Z A t-6-2- 'T� o2S� O 1 <br /> Print Name Sign Name Date <br /> PAMountain House\2496\Supplemental Ag.Checklist.doc <br />