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6 <br /> SUPPLEMENTAL QUESTIONNAIRE FOR AGRICULTURAL SITES <br /> APN 173-210-04 THROUGH 173-210-07 <br /> L <br /> What is your relationship to the property? OdOwner ❑ Occupant <br /> L ❑ Grower ❑ Other <br /> How long? �eS <br /> L Is the property currently used for any agricultural Yes No Unk <br /> use? <br /> What type of crop? <br /> L <br /> Are there any pesticides currently being used on the Yes No Unk <br /> property? <br /> If yes,please list what types: <br /> Do you observe evidence or have any prior Yes No Unk <br /> knowledge that pesticides were used on the <br /> property? <br /> Please Describe: <br /> Are any adjoining properties being used for an es No Unk <br /> agricultural use? <br /> If so,please indicate which ones: North South East West <br /> ` What types? CA&K -01 2S <br /> Are there any pesticides currently being used on any Yes No Unk <br /> adjoining properties? <br /> tr <br /> If so,please indicate which ones: North South East West <br /> If yes,please list what types: <br /> Do you observe evidence or have any priorYes No Unk <br /> knowledge that pesticides have been used on any <br /> adjoining properties? <br /> V <br /> If so,please indicate which ones: North South East West <br /> Please Describe: <br /> to / <br /> Initials <br /> P:U916 East Main Street Development (Grupe)\3916 E Main Street Development Phase l\Correspondence\Leaers\Supp. Ag. <br /> Turbetti.doc <br /> r <br />