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ENV ONWWAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CML ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> 1.Date you acquired property Y;W- 0— (1 l SJ Co. <br /> 2.Use of property since acquisition_ re 5 ` <br /> 3.How many irrigation wells serve the property: 1 Depth of well(s)if <br /> known <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?if yes,for what years ?!�^ c� <br /> Describe the products produced wes <br /> 5.Do you have any knowledge of any of the following tieing present on the parcel under study? <br /> A.Any disposal site,by formerlpremd owner,of fuels,hamdous materials,chemicals or any other <br /> substance considered a controlled substance:by LocaUSta#,eJl<edWA Law. Yrs , No--2<— <br /> (if Yes, <br /> please explain. <br /> B.Existing cisten%hand dug well or leach field,no longer in use.Yes No X {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 X <br /> D.Flooding of parcel in part,or whole. Yes No >C Nyes what years <br /> E.Contamination of air or soil from 4800A parcels Yes—No <br /> F.Failed septic system,that required,repair or additional work_Yes No >e-_if yes describe work <br /> done <br /> G.A pnoripresent condition that may preclude developement ofthe p ei(s}.Yes No X <br /> IL A specific location where equipm rtfueled-Yes No-.,,"'- <br /> 6.Name of farmer owner L h l Do you know what use was <br /> made of the land by the owner?If so,please describe l �-e- C J5!�-S <br /> 7.Has the land been deep ripped since owned by you?Yes No X <br /> S.Are you aware of arty perched water table/springs or on occasion pools of water on site?Yes No t <br /> Comments: <br /> (OwnedRep. Signature) Date t <br /> ��TK 3 3 Y -0633 <br />