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a <br /> ENVIRa ALUE <br /> � <br /> Q sTrazvw.AnE <br /> TO BE COMPLETED BY OWNERIOWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> Y AND ASSOCIATES, CIVIL ENGINEERS FOR.INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> I-Date you acquired roP ' _� APN: /D�� Z/ " 0 <br /> - S3 Co. <br /> 2.Use of property since acquisition <br /> 3_How many irrigation wells serve the Proper' <br /> Depth of well(s)if <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years g o oa-cher <br /> Describe the products produced <br /> 5-Do you have knowledge Y any of any of the following being present on the parcel��.study? <br /> A-Any dispose!site,by fanner <br /> �^ /present owner,of hek%hazardous rials,chemicals or any other <br /> substance considered a controlled substance by 1-00"Weffiederal Law- Yes No <br /> please explain. ��(If Yes, <br /> B. Existing cistern,hand dug well or leach field,no longer in use-Yes <br /> please locate on No-� V (Ifyes <br /> property far the field review whicb is to be complied afar receipt of this form-) <br /> C. Structures that are considered unsafe by you or local authorities. Yes No w i M SMALL <br /> D. Flooding of <br /> parcel in part,or whale. Yes 'V�NQIf ; ---- <br /> E.Contamination of air or soil from adjacentpals Yes No m'whaty FTfR f/�A RAI N C o RNFI� <br /> Y F. Failed septic ysem,that r or additional wY - vdone <br /> yes describe work <br /> G-A prior/present condition that may preclude devel <br /> opement of the parcel(s).yes No V <br /> H.A specific location where equipment was is fueled Yes No V <br /> 6.Name of former owner ETE' o ev <br /> made of the laced by the owner? <br /> If-so,please describE� ER , Do you know what use leas - <br /> �' S 7v <br /> . i <br /> 7. Has the land been,deep ripped since owned by you?Yes No <br /> 8-Are you aware of any perched water tabletsprings oron occasion <br /> Pools of water on site?Yes NNo!r <br /> Comments: <br /> i <br /> i <br /> (Owner/Rep.Signawre) Date <br />