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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE AND ASSOCIATES,LETEDBY <br /> ENGINEERS FOR INCLUSIONER/OWNER'S REP" IN URFACE SUUB SURFACE ED TO EARNEST F. SMITH <br /> CONTAMINATION REPORT. / <br /> 1. Date you acquired property:�, W,, I'O APN: I S S SJ Co. <br /> 2. Use of property since acquisition <br /> 3. How many irrigation wells serve the property:. Iv nQ Depth of well(s)if <br /> known O <br /> 4. Do you have a permit to apply chemicals or fertilizers to the parcel? If yes, for what years N <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 ny other <br /> substance considered a controlled substance by LocaVState/Federal Law. Yes No <br /> (If yes, <br /> please explain. <br /> B. Existing cistern, hand dug well or leach field,no longer in use.Yes No t pf 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 authorities. Yes No I/ <br /> D. Flooding of parcel in part,or whole. Yes No V If yes what years <br /> E. Contamination of air or soil from adjacent parcels Yes No V <br /> F. Failed septic system,that required repair or additional work.Yes Nf yes describe work <br /> done <br /> G. A prior/present condition that may preclude developement of the pacyel(s). Yes No <br /> H. A specific location where Uequipment was,is fueled. Y No V <br /> 6.Name of former owner (,Ik ML 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 /> 8. Are you aware of any perched water table/springs or on occasion pools of water on site? Yes—No— <br /> Comments: <br /> esNo-Comments: <br /> 4( �I/Rep. ignature) Date <br />