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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP., AND FORWARDED TO EARNEST F.SMITH <br /> AND ASSOCIATES,CIVII.ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. ^ G <br /> 1. Date you acquired property 9 -I-OR APN: (00 -7 -"/2(2-- OK' SJ Co. <br /> 2. Use of property since acquisition 'C 1�- TA L ,L [40 ryl l 1'1 G_ <br /> 3.How many irrigation wells serve the property:-7Z Depth of well(s)if <br /> known <br /> 4. Do you have a permit to apply chemicals or fert'lizers to the parcel?If yes, for what years �) <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 former/present owner,of fuels,hazardous materials,chemicals or any other <br /> substance considered a controlled substance by Local/State/Federal Law. Yes N6 (If yes, <br /> please explain._ k h" N r <br /> B. Existing cistern,hand dug well or leach field,no longer in use. Yes No +/ (If yes <br /> please locate on property for the field review which is to be completed after receipt of this form.) <br /> C. Structures that are considered unsafe by you or local authoriti Yes No t / <br /> D. Flooding of parcel in part,or whole. Yes No If yes at years <br /> E.Contamination of air or soil from adjacent parcels Yes No <br /> F. Failed septic system,that required repair or additional work. Yes No�/If yes describe work <br /> done <br /> G. A prior/present condition that may preclude developement of the parcel(s). Yes No___,_ . . <br /> H. A specific location where equipment was/is fueled. Yes No <br /> 6.Name of former owner GOq2LcS P-AL# 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 /> S. Are you aware of any perched water table/springs or on occasion pools of water on site?Yes No <br /> Comments: <br /> (Owner/Rep. Signature) Date <br /> r <br />