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Surface Subsurface Report Questionnaire <br /> Project Name Page 9 of 10 <br /> Our Project Number: XXXXXX <br /> May 31, 2007 <br /> IV. INDUSTRIAL PROPERTIES <br /> Is the property currently used for any industrial purpose? <br /> ❑ Yes tgNo <br /> Has the property ever been previous used for an industrial purpose (other than <br /> the current use)? El Yes -o <br /> If the answer to either question is"yes,"please answer the following: <br /> 1. Has the property been used for disposal of any liquid or solid waste? <br /> ❑ Yes No <br /> 2. Have evaporation or storage ponds been located on the property? ❑ Yes No <br /> 3. Have waste water treatment facilities, such as acid neutralization vaults, <br /> been located on the property? <br /> Yes No <br /> 4. Are there raw chemical or waste chemical storage areas on the property? ❑ Yes No <br /> If any of questions 1-4 are answered"yes,"please provide a description, including the location of all <br /> disposal sites, treatment facilities and storage areas, the type of chemicals or wastes handled at each <br /> site, the results of any soil or groundwater samples taken in the vicinity of each site, and the manner <br /> in which each site not presently in use was closed. <br /> V. AGRICULTURAL PROPERTIES <br /> Is the property currently used for agricultural purposes, other than grazing or Yes ❑ No <br /> pasture land? <br /> To the best of your knowledge, has the property been used in thep ast for [VYes 0 N <br /> agricultural purposes, other than grazing or pasture land? <br /> If the answer to either question is"yes," please answer the following: <br /> 1. Have pesticides, herbicides or other agricultural chemicals been applied Yes ❑ No <br /> to the property? If so, please describe the locations where such <br /> pesticides, herbicides or chemicals were applied, and the type of Awp_ e <br /> pesticides, herbicides or chemicals applied in each area. (Please attach f <br /> copies of pesticide use reports ifauailable.) <br /> 2. Have pesticides, herbicides or other agricultural chemicals been mixed, <br /> formulated, rinsed, or disposed of on the roe ❑ YesNo <br /> the locations where such pesticides, herbicides or chemcalslwe were <br /> formulated, rinsed, or disposed, and the type of pesticides, herbicides or <br /> chemicals mixed, formulated, rinsed or disposed of at each location. <br /> 3. Has any soil or groundwater analysis been performed to detect <br /> pesticides, herbicides or chemicals used at the site? If so, please provide <br /> ❑ YesNo <br /> a summary of the findings or attach the report(s). <br /> 902 Industrial %Vay• Ludi.C:1 95240• 209.367.370I • fas 209.369,4228 . .� - <br /> C-_007 Neil()-Anderson&. rrncrolzr.lu2'_ <br />