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VIG�s�—T ( I/ 0", J� cam_ <br /> ;AS'9(0C) � ( Cr %N6LA-r <br /> ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COhIPLETED BY OWNER/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES; CIVIL ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> 1. Date you acquired property L L-��APN• Si Co. <br /> 2.Use of property since acquisition 1 <br /> — Ct,4 � <br /> 3.How many irrigation wells serve the property: Depth of well(s)if <br /> known <br /> _ 4.Do you have a permit to apply chemicals or fertilizers to the parcel?Ifyes,for what years—nl:C� <br /> Describe the products prodtxxd <br /> 5. Do you have any knowledge of any of the following being Ott on the parcel under study? <br /> A. Any disposal site, by formes/present owner,of firels,,hk rdous materials, chemicals or any other <br /> substance considered a controlled substance by LDcaUState/Federal Law. YcsNo_>_(If yes, <br /> please explain. <br /> B. Existing cistern,hand dug well or leach field,no longer in use.Yes No (If yes <br /> please locale on property for the field review which is to be completed after receipt of this fX) <br /> C. Structures that are considered unsafe by you or local authorities. Yes No <br /> D. Flooding of parcel in part,or whole. Yes No x If es,what years <br /> 1~ Contamination of air or soil from a&jacent parcels Yes No ' <br /> .. F.Failed septic system,that required repair or additional wrorlr Yes No If yes describe work <br /> dont <br /> G. A prior/present condition tient may preclude developernent of the (s).Yes No <br /> H. A specific location where equipment wasps fueled. Yea No <br /> 6.Name of former owner Do you know what use was <br /> made of land o so,please desch <br /> t Z1 <br /> 7.Has the land been dkip ripped since owned by you?Yes No <br /> 8. Are you aware of any perched water table/springs or on occasion pools of watts on site?Yes—No <br /> �- Comments: <br /> _,7t� ZD,4q L4f C)q <br /> ` ( Si Date <br />