Laserfiche WebLink
1 <br /> SITE IDENTIFICATION FORM <br /> (Atueh iddjdaeel dewflpdan or axphmdon a needed.) <br /> Initlgl I.D. s its • Follow-Up Investigation (Y/N): <br /> SI'Z'E INFORMA'T'ION <br /> Site Name: L14t,/ZEN2cF <br /> AKA: S.mz _Rcp - - <br /> SWIS #: County:zA-.),- yAia,_•,.JParcel #(s): <br /> Location: irf % - --.4� Mai 4 _� oma, -r-r-A c44 <br /> InOe Lannon Or lMG.Ma "IM ■OWNhIPWRIkele,sea w...•.,n,and.....o....8r.) <br /> Land owner(s): _Ike rv-au •t�oi E.,/,cjeA '. u• S. c�yac,e,✓,4�('Xc_^J ' <br /> Address: <br /> City: State• Zip: Phone: <br /> Types of Waste: Ine Res., Com., Indust., Nat., Liquid <br /> Site.Type: Illegal Dumping, Ltnom Burn Dum •n►-��G Treetn*nt Unit <br /> Disposal Area (Aare) i SWFP Date: WDR Num err: -- <br /> Dates of Operations'. 4 ee t lftD Closure Approved By: <br /> LAND USE ON OR WITHIN 1000 Fr 1 MILE OF WASTE BOUNDARY <br /> Rural: <br /> Residential: ies- <br /> Commercial: Ye e3 N <br /> Industrial: <br /> Environmental Sensitive: M Net No <br /> Water Supply Wells: es <br /> Surike Water Bodies: es es N <br /> Inhabitable Structures: Yes No <br /> Enclosed Structures: es <br /> Planned Improvements: Yes No Yes No _ <br /> OBSERVATIONS <br /> Date of Field Visit: q/-/& 1-3 Sig. Change Since.Last Visit? (Y INA • <br /> Surface Condition: nQ face-z-1- �P ac�e •.-e <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOMMENDATION <br /> Emergency Response: <br /> Otho' (e.g. small was illegal dumol that wuiants re=vtd):' <br /> Reassess Site? (Y/NINA): No Further Action? (D priority YIN): <br /> Priority for Site Asses t I &d/Lnw): <br /> pfd By: -s Date: 47t q <br /> CIWMB Approval: h compliance <br /> CIWWB Clowre and Remediadon Branch(Rev.371OM) <br /> Board Approved"M) <br />