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` V%., *4J <br /> SUPPLEMENTAL QUESTIONNAIRE FOR AGRICULTURAL SITES <br /> APN 173-210-05 <br /> ,v <br /> What is your relationship to the property? ® <br /> Owner ❑ Occupant <br /> ❑ Grower ❑ Other <br /> Howlong? yYrs - ir7 famd/y P�e✓lous -6 f60cf <br /> Is the property currently used for any agricultural Yes No Unk <br /> use? <br /> What type of crop? <br /> V <br /> Are there any pesticides currently being used on the Yes No Unk <br /> Lproperty? <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.+R <br /> o tk+1 ne, Q Q pe5-h C t c) c S <br /> Are any adjoining properties being used for an Yes No Unk <br /> agricultural use? <br /> If so,please indicate which ones: North South East West <br /> What types? <br /> bw <br /> Are there any pesticides currently being used on any Yes No Unk <br /> adjoining properties? <br /> %W 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 prior Yes No Unk <br /> knowledge that pesticides have been used on any <br /> adjoining properties? <br /> r If so,please indicate which ones: North South East oes <br /> Please Describe: <br /> r <br /> Initials <br /> P93916 East Main Street Development(Gmpe)\3916 E Main Street Development Phase 1\Correspondence\Letters\Supp. Ag. CL(- <br /> 05).doc <br /> it <br />