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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED 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. Dau you acquired property 2. q 3 0 APN• 0 617 -310 ^ I SI Co. <br /> 2.Use of property since acquisition <br /> 3.How many irrigation wells serve the property: Depth of well(s)if <br /> known_nL-P0 <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?Myes,for what years /J0 <br /> Describe the products produced <br /> 5.Do you have any knowledge of any of the following being present on the parcel under study? <br /> A.Any disposal site,by formedptesent owner,of fuels,hetipdous materials,chemicals or any other <br /> substance considered a controlled substance by Local/State/Federal Law. Yes No_ 2C, _(If yes, <br /> please explain. <br /> B.Existing cisum,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 h to be completed atter receipt of this form.) <br /> C. Structures that are considered unsafe by you or local authorities. Yes X No <br /> D.Flooding of parcel in part,or whole. Yes No_2�__If yes,what years <br /> E.Contamination of air or soil from adjacent parcels Yes Nom_ <br /> F.Failed septic system,that requited repair or additional work.Yes No_)�__If yes describe work <br /> done ►Jif ,56f',TC .9)r5i JA <br /> G.A prior/present condition that may preclude developemeut of the parcel(s} Yes No_?S_ <br /> H.A specific location where equipment was/is fueled.Yes No_ )(_ <br /> 6.Name of former owner Do you know what use was <br /> made of the land by the owcell If so,please describe <br /> 7. Has the land been deep ripped since owned by you?Yes—No- <br /> S. <br /> esNo- <br /> S. Are you aware of any perched water table/springs or on occasion pools of water on site?Yes_No4 <br /> Comments: <br /> /S JUAe- 'r 200 <br /> (Owner)Rep.Signature) Date <br />