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CHECKLIST * IDENTIFICATION OF SURFACE IMPODMENTS <br /> SUBJECT TO THE TOXIC PITS CLEANUP ACT (TPCA) <br /> (Complete one form for each impoundment) <br /> Regional Board: 2EC1 1o,.l '5 Date of Report: <br /> Inspector: spy fel L I Date of Inspection: <br /> I. OWNER INFORMATION <br /> NAME CORP. , INDIVIDUAL OR PUB. AGENCY) PUBLIC AGENCY ONLY PHONE "/AREA <br /> 001 FED Xb 2 STATE 003 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> P.v. aux �8 —Kfbn) cf} 9s1s8 <br /> II. FACILITY INFORMATION <br /> FACILITY NAME CONTACT PERSON OPERATOR <br /> EU- OoKAL}� �1 Y1 l c.A C.O. I LFl 2/Z E-0C?OGJ E <br /> STREET ADDRESS NEAREST CROSS STREET <br /> IJ05 6. - c,WAV-1- .a- cJ <br /> ------ <br /> CITY <br /> -:51A4 J_6Ap u (A 15LA5 <br /> MAILING ADDRESS CITY STATE ZIP <br /> Po . Box 3 7s�l 'iAi l ML, 8 2 <br /> PHONE N AREA TYPE OF BUSINESS <br /> Of5)4Vo -8 43 cat-L. "o.rl Lt LA 2r-2 <br /> TOTAL NO. OF IMPOUNDMENTS RURAL AREAS ONLY TOWNSHIP RANGE SECTIDN <br /> III. IMPOUNDMENT INFORMATION Column A Column B <br /> Name and/or number: Subject to TPCA Not Subject to TPCA <br /> a. Contents _�G waste or _ product <br /> b. Nature YL hazardous or non-hazardous <br /> c. Construction/Design earthen or X non-earthen <br /> or other materials with <br /> non-structural independent , <br /> materials structural <br /> integrity <br /> d. Discharge (including storage) Has occurred or none after <br /> on or after ~ 12/31/84 <br /> 1/1/85 <br /> IV. CONCLUSION (check appropriate box) <br /> A. 0 IMPOUNDMENT MEETS ALL OF THE CRITERIA IN COLUMN A AND IS SUBJECT TO THE TPCA. <br /> B. IMPOUNDMENT MEETS Ti LEAST ONE CRITERION IN COLUMN B AND IS NOT SUBJECT TO <br /> THE TPCA. <br /> C. INSUFFICIENT INFORMATION AVAILABLE, CONCLUSION PENDING. <br /> IF SUBJECT TO THE TPCA, COMPLETE NEXT PAGE. <br />