Laserfiche WebLink
Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: E06057A <br /> Property Location: 11981 S. Roberts Road, Stockton, CA 95206 <br /> Page 11 <br /> 2. Have pesticides, herbicides or other agricultural chemicals been mixed, ❑ Yes 6N <br /> formulated, rinsed, or disposed of on the property? If so, please <br /> describe the locations where such pesticides, herbicides or chemicals <br /> were mixed, formulated, rinsed, or disposed, and the type of <br /> pesticides, herbicides or chemicals mixed, formulated, rinsed or <br /> disposed of at each location. <br /> 3. Has any soil or groundwater analysis been performed to detect ❑ Yes No <br /> pesticides, herbicides or chemicals used at the site? If so, please <br /> provide a summary of the findings or attach the report(s). <br /> ENDORSEMENTS: <br /> Part 2 <br /> As the present owner of the property or as an officer or general partner of the present owner of the <br /> property (or the duly authorized representative of such owner), I am familiar with all of the operations <br /> presently conducted on the property, and hereby certify that to the best of my knowledge, <br /> information, and belief the information disclosed above is t ue and correct. <br /> ner or Key ite Manager's Signature Date <br /> :,]ad lzt <br /> Owner gr Key Site Manager's Name (please print) <br /> Title, Company <br /> r.. <br /> If you have any questions about this questionnaire,please contact Abby Racco at(209)36 7-3 701 ext. 238. <br /> '004 r. <br />