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,r <br /> SI'Z'E IDEN` 1FICA11ON FORM <br /> (Atueh Witioeel deeetipdon or ezplanaGen as needed.) <br /> Initial I.D. : -es . Follow-up Investigation (YEN): <br /> SITE INFORMATION <br /> Site Name: LA-f, ,. ci LI A-ew el — IC'r72 3en',Q <br /> AKA: St —c 3Gv <br /> SWIS #' —County:,S.a�.� ��.JParcel #(s): .?W/.— IYo -- ys <br /> Location: C_ <br /> (Muille Location ormap Min I owns tp, ange,and section,an ,roeMap.) <br /> Land Owners):��,=. ,e�r r�,.r�o . z.�.�e��' . u• S. C�✓,r,Q,✓.� .�'7— <br /> Address: <br /> City: State:—Zip: Phone: <br /> Types of Waste: Inert Res.$ Com., Indust. az: Liquid <br /> Site.Type: eget Dumping, Landfill, Burn bum Treatment Unit <br /> Disposal Area (Acre): i 'Q . - SWFP Date: WDR Num er: <br /> Dates of Operations: 149 Closure Approved By: <br /> LANI) USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: o <br /> Residential: as es <br /> Commercial: Yea es N <br /> Industrial: Y o <br /> Environmental Sensitive: es No <br /> Water Supply Wells: Yes o <br /> Surface 'Water Bodies: Yea o es <br /> Inhabitable Structures: Yes YesNo <br /> Enclosed Structures: es . e, o <br /> Planned Improvements: Yea No Yes No <br /> OBSERVArtIONS <br /> Date of Field Visit:.�•Y /� 13 Sig. Change Since Last Visit? (Y/6A;:� <br /> Surface Condition:,.(qwej ay Q ce Z <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOMMENI)ATION <br /> Emergency Response: <br /> Othet (e.g. small sWe illegil dumping that wtltants temoval):' <br /> Reassess Site? (YININA): No Further Action? (D Priority Y": <br /> priority for Site Assess t eti/Iuw): <br /> Prepared By: s Date: 4 <br /> CIWMB Approval: Cdcl! ch compliance <br /> CrNMB Closure end Remediation Branch(Rev.410/93) <br /> Board Approved(2/25/93) <br />