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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNFdt/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUS"4 IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> I.Daft you acquired Property—/ 13 I APN: Oo _3 00 —0 8 Co <br /> I Use of property since acquisition _6rz otiJ A t m i G 4cv ti� v= g n a S �r z �� <br /> 3.How many irrigation wells serve the property: oN(= Depth of weli(s)if <br /> known A oG ' <br /> 4_Do you have a permit to apply chemicals or fertilizers to the parcel?ffyes,for what years/492 - zooms <br /> Describe the products produced {-LgTS GF GC:O�--�J CGv�Q <br /> 5_Do you have any knowledge ofany ofthe following being lit on the parcel under study? <br /> A-Any disposal sde,by f owner,of fuelslikaudous Mals,chemicals or a"other <br /> substanceconsidered a eoouolted substance by LoeaVStatdFederal Law_ Ys No X Of yes, <br /> please explain. <br /> B. Existing cistern,hand dug well or lead field,no longer in use.Ycs No .x (If yes <br /> please locate on property for the field review why is to be completed atter receipt ofthis form.) <br /> C. Structures es that are considered unsafe by you or local authorities_ Yes No X <br /> D.Flooding of parcel in part,or whole. Yes No X ffyes,what years <br /> F Cotpantitmt;on of air or soil from adjaccui parcels Yes No—)( <br /> F_Failed septic system,the required repair or additional wok.Yes No_,?�_Ifyes describe work <br /> done <br /> G_A pnodpresent condition,amt may preclude devewpemcnt ofthe patcd(s)_Yes No <br /> H.A specific location where egmpmart wW&fueled_Yes No X <br /> 6.Nmneofformerowner Ar,-rHuQ k+. aEaD - <br /> made ofthe land the owM?If so Do know what use was <br /> by ,please describe PAScucLr Go.2 C-r+rr�c <br /> 7.Has the land been deep ripped since owned by you?Yes No k <br /> S.Are you aware of any perdted water tabkelsprings or on occasion pools of water on site?Yes No X <br /> Comments: <br /> / 7 !/ i ca <br /> OwnerM,. Signature) Date <br />