Laserfiche WebLink
06/28/2006 10:X16 9565692 DELTA HOME REPAIR <br /> F'AGE 1'� <br /> � <br /> ale 4uestioMaire <br /> 5ui�[ece and Sutnurface Contamina►tion P� <br /> MOA Pra jest Number: eo"5A <br /> prop "L=tw ,: 20M 13P Street> Stockton, GA 952036 <br /> page 1 I []Yes t!a <br /> ,�idvs, herbWdOs or other agricultural ctx�mlCals been mixed, <br /> �. Nave[ or disposed of on the provenrt?�' {f so, r the <br /> ptease <br /> farmulxtted, rtrts+bti, whew such pesticides, erbecide}c+r chemicals <br /> describe thr locations �¢ and the type of <br /> were mixed,formulated, rinsed, or dis rinsed or <br /> miticides, herbicide's or chemitats mixed, formutated. <br /> djspoW Of at each totation. <br /> Yes (�Jb <br /> Ha's <br /> ter aMaty5is been Performed to detect J` <br /> 3, pee any y0it or grcoundwa► site? if so, p <br /> pesticides, herbicides or chemicats��>acth the report{g�` <br /> provide a summary of the findings <br /> E14DORSEMENTS: <br /> of of the prasent owner Of the <br /> As sp�lee present owner of tM pr y opt"n offative f gy,�h Wner�!partnervl �famft9ar with act of the operations <br /> or the duty avthorixed 4'Pr� and hereby certify that to the best of my knowted"' <br /> prese�Y conducted on the vy disclosed above is true end correct• <br /> inforroattion, And Witt tt�information <br /> o <br /> S t Mariagcr`s mature <br /> r <br /> o_�� • - <br /> ,+m '{please p nE <br /> Tine, ornpany <br /> ff pnrr hcnro any 4rraaNaze uhaNr thin �g- <br />