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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNEWOWNER'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 propertyj) n�APN: d O q— 60-- ( J/Co. <br /> 2.Use of property since acquisition{ P rS B>7 0. 9 T2 Y �N rc- /cYc ne-(f <br /> 'v''�pnCe. -Mle <br /> 3.How many irrigation welts serve the property: Depth of weli(s)if <br /> known_ <br /> 4.Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years A/ <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 Fortner/present owner,of fuels,hazardous materials, chemicals or anY other <br /> _ substance considered a controlled substance by Local/State/Federal Law. Yes No t/ (If yes, <br /> please explain. <br /> B.Existing cistern,hand dug well or leach field, no longer in use. Yes?No <br /> T_(If yes <br /> please locate on property for the field review which is to be completed after receipt of this foffrL <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 If yes,�yhat years <br /> E.Contamination of air or soil from adjacent parcels Yes No <br /> F. Failed septic sy em,that required repair Qr additional work. Yes +/No yes describe work <br /> done A�Fr C vvi (d r r1 YJ! -C6(-r Jc'r D t1 41-5' <br /> G. A prior/p ent condition that may preclud developement of the 1(s). Yes No <br /> H. A specific location where equipment was/is fueled. Yes No <br /> 6.Name of former owner ✓ 11 Do you know what use was <br /> made of the land by the owner?If so,please describe <br /> 7. Has the land been deep ripped since owned by you?Yes No <br /> 8. Are you aware of any perched water table/springs or on occasion pools of water on site?Yes— <br /> No-Comments: <br /> (Owner Signature) Date <br />