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SUPPLEMENTAL QUESTIONNAIRE FOR AGRICULTURAL SITES <br /> APN 173-210-05 <br /> What is your relationship to the property? '5L O� ❑ Occupant <br /> ❑ Grower ❑ Other <br /> How long? 61rlce - Iqt9q ({� � �)f (op (fczr5) <br /> 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 /> !r <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: rOU 11 <br /> r co I tura( ii <br /> Are any adjoining properties being used for an Yes No Unk <br /> agricultural use? <br /> L <br /> If so,please indicate which ones: North South East West <br /> What types? <br /> r. <br /> Are there any pesticides currently being used on any Yes No Unk <br /> adjoining properties? <br /> If so,please indicate which ones: North South East West <br /> If yes,please list what types: <br /> tr <br /> lr. Do you observe evidence or have any prior Yes No Unk <br /> knowledge that pesticides have been used on any <br /> adjoining properties? <br /> ►� If so,please indicate which ones: North South East West <br /> Please Describe: r0 Ttltn-e Qgr(CU '�Ltra-f pe51 iCIe4es <br /> Initials <br /> P13916 East Main Street Developrnent(Grupe)\3916 E Main Street Developrnent Phase 1\Correspondence\Letten;\Supp.Ag. CL(- <br /> 05).doc <br /> rr <br />