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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,C111L ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT. <br /> Y 1. Dale you acquired property—M-7-7 J I-7 <br /> `"&J(0 `CN��_SJ Co. <br /> 2. Use of property since acquisition 117��Ivle ak Ck <br /> y 3.How many irrigation wells serve the property: I-Y0A ee e of wells}if <br /> ]mown <br /> 4. Do you have a permit to apply chemi s or fertilizers to the parcel?If yes,for what years:S , ,, <br /> Describe the products produced�� -.-.-- <br /> y 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 any other <br /> substance considered a controlled substance by Local/Su t Nederal Law. Yes No_,Z (If yes, <br /> please explain. <br /> B. Existing cistern,hand dug well or leach field,no longer in use. Yes No X (If 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�_ <br /> D. Flooding of parcel in part,or whole. Yes No� X.—If yes, what years <br /> E.Contamination of air or soil from adjacent parcels Yes NoX— . <br /> F. Failed septic system,that required repair or additional work.Yes No 1f yes describe work <br /> done <br /> G. A prior/present condition that may preclude developement of the parcel(s). Yes No__�f _ <br /> H. A specific location where equipment was/is ftled. Yes'2LNo <br /> 6.Name of former owner LkC-� a� Doau knovy what use was <br /> made of the land by the owner?If so,please describe -;Et <br /> 7. Has the land been deep ripped since owned by you <br /> 8. Are you aware of any perched water table/springs or on occasion pools of water on site? Yes No_.�X_ <br /> Comments- <br /> ( /Rep. Signature) <br /> l� <br />