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Surface Subsurface Report Questionnaire <br /> ^� Project Name <br /> Our Project Number; XXXXXX Page 4 of 10 <br /> May 31, 2007 <br /> NEIL O. ANDERSON & 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 <br /> /Lry <br /> — Name: <br /> Address: 5x25 1�1/, v� � i2 <br /> D, Lod, , <br /> _ Telephone: &)91 - 3 (� O — <br /> Year purchased: 1961 <br /> 2. Previous owner(s) and contact information (if known): <br /> Name: �/ -, <br /> Address: �� wavio <br /> Telephone: <br /> Year purchased: <br /> 3. Other person with historical knowledge Of property: <br /> — Name: �/ <br /> Address; NIA- <br /> Telephone: <br /> Relationship to property: <br /> 4. Please describe current use(s) of property: <br /> I � 6a e, v; <br /> 5• Please describe any other known past uses) of property, and approximate dates of each use: <br /> �f <br /> 902 Industrial Wap• Lodi.C'A 95240•209.367-3701 -Fax 209.369.4228 "04 L <br /> . <br /> ' <br /> 3`i?007 A'ell O.A...1,r'son r4.lSsnrirm•o 6,,. <br />