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geophysics - environmental - geology <br />ENVIRONMENTAL QUESTIONNAIRE AND DISCLOSURE STATEMENT <br />APN: 209-450-35 <br />18201 W GRANT LINE ROAD <br />MOUNTAIN HOUSE, CALIFORNIA <br />PART 1: USER'S RESPONSIBILITIES <br />(To be completed by the Client) <br />Petralogix Engineering, Inc. is preparing a Surface & Subsurface Contamination Report (SSCR) for the <br />above referenced property in order to identify environmental concerns such as leaking tanks, chemical <br />spills, or other such issues on or near the property that may be incompatible with the proposed future <br />land use. <br />We ask that you complete the following questionnaire and email it to tscheftner@petralogix.com. We will <br />include this in the Surface & Subsurface Contamination Report as an appendix. We appreciate your time <br />and encourage you to call us at 209-770-0731 with any questions about this or any of the items contained <br />with this document. <br />Yes No <br />1. Have any previous environmental reports or title reports been prepared for the <br />property? (If yes, please provide copies of any available reports.) ❑ ❑ <br />Title report included. <br />Aak <br />petralogix <br />26675 Bruella Road • Galt, CA 95632 • 209.400.5729 <br />