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1 <br /> SITE IDENTIFICATION FO <br /> (Attach additional description or explanation as needed.) <br /> Initial I.D. - Ves . Follow-up Investigation (Y/N): <br /> SITE INFORMATION �/7 �1 <br /> Site Name: L„-,Az4En2 c�6 <br /> AKA: T a� -3no - <br /> SWIS #: County: sj4.*J,7VACAgat -)Parcel #(s): a6/.- IL - <br /> Location <br /> (Include ation orMap WIM 1 ownship, sage,and Section,and ParcelMap.) <br /> Land Owner(s):_ ,J- of � 6r u S ze✓� Ae W, A <br /> Address: <br /> City: State: Zip: Phone: <br /> Types of Waste: Inert, > Res., Com., Indust., Haz.', Liquid <br /> Site.Type: egal Dumping, Landfill, Bum Dum , '7��c- tment Unit <br /> Disposal Area (Acre). 1 SWFP Date: WDR Num <br /> Dates of Operations:�� 1, �RC� Closure Approved By: ' ' �..�. Z <br /> LAND USE ON OR WITHIN OF WASTE BOUNDARY <br /> Rural: Yes Yes No <br /> Residential: Yes o es No <br /> r <br /> Commercial: Yes No4;e;, <br /> Industrial: Yes N <br /> Environmental Sensitive: Y <br /> Water Supply Wells:Surface Water Bodies: Yes NInhabitable Structures: Yes N <br /> Enclosed Structures: Y No No <br /> Planned Improvements: Yes No Yes No <br /> OBSERVATIONS <br /> Date of Field Visit: q3 Sig. Change Since Last Visit? (Y�A -: J14- <br /> Surface Condition: e,, ' 6yT3 C <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOMMENDATION <br /> Emergency Response: <br /> Other (e.g. small scale illegal dumping that warrants removal): <br /> Reassess Site? (YIN/NA): No Further Action? (D Priority Y/1): <br /> Priority for Site Assess fit ed/Low): <br /> Prepared By: Fly Date:—4, q <br /> CIWMB Approval: C&1F ch Compliance <br /> C1wMB Closure and Remediation Branch(Rev.3T10/93) <br /> Board Approved(2/25/93) <br />