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Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: E06057A <br /> Property Location: 11981 S. Roberts Road, Stockton, CA 95206 <br /> Page 5 <br /> NEIL O. ANDERSON Ft ASSOCIATES, INC. <br /> ENVIROMENTAL QUESTIONNAIRE AND DISCLOSURE STATEMENT <br /> PART 2: OWNER INFORMATION <br /> (To be completed by Owner or Owner's representative) <br /> I. GENERAL INFORMATION <br /> 1. Current owner of property Q rr <br /> Name: <br /> Address: <br /> Telephone: <br /> Year purchased: z(5U c5 <br /> 2. Previous owner(s) and contact information (if known): <br /> Name: a 4 <br /> Address: <br /> Telephone: <br /> Year purchased: <br /> 3. Other person with historical knowledge of property: <br /> Name: <br /> Address: <br /> Telephone: <br /> Relationship to property: <br /> 4. Please describe current use(s) of property: <br /> 5. Please describe any other known past use(s) of property, and approximate dates of each use: <br /> If you have any questions about this questionnaire,please contact Abby Racco at(209)367-3701 ext.238. <br />