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SITE IDENTIFICATION FORM <br /> (Attach additional deaetiption or explanation as needed.) <br /> Initial I,D,6�0: es . Follow-up Investigation (Y/1): <br /> StM INFORMATION <br /> Slte Name: LAia, .�E�c6 v:E�.-ro.2 — c•� 3��� <br /> AICA: S f-z� -300 <br /> SWIS #: County:,s-A ).-jvAcotL,JParcel #(s): 067 <br /> Location: ff <br /> (Incluas Location or Quia.map With Township,/Hange,and Section,and ParcelMap.) <br /> Land 0wner(s): i E.w7wear'-0 EnK-c-eG y' u• S ez-e t2.✓��.�T <br /> Address: <br /> City: State: Zip: Phone:_ <br /> `hypes of Waste: Ittett Res., Coln., Indust., a Liquid <br /> Site.`hype: a Dumping, Landfill, Bute Dum ,Tr�nc L Treatment Unit <br /> Disposal Area (Acre): ,� SWFP Date: WDR Num er: <br /> Dates of Operations:e-e -j q£j Closure Approved $y: 777,s - " <br /> LANI) USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: o <br /> Residential: Ya Yes o i <br /> Commercial: Yes o es o <br /> Industrial: Y <br /> Environmental Sensitive: <br /> Water Supply Wells: Yes oNo <br /> Surface Water Bodies: Yes Yes No <br /> Inhabitable Structures: lies XgNo <br /> Enclosed Structures: Yes <br /> Planned Improvements: Yes No Yes No <br /> OBSER VArnONS <br /> Date of Field Visit: 'q11&1'?-3 Sig. Change Since Last Visit? (Yj 21NA ' <br /> Surface Condition: <br /> Landfill Clan: <br /> Leachate: <br /> Other: <br /> RECOMWNI)ATION <br /> Emergency Response:. <br /> Other (e.g. small sale illegal dumping that warrants removid):' <br /> Reassess Site? i 14A): No Further Action? (D priority Y": <br /> Priority for Site,Assess tt ed/Low): <br /> . . prepared By: s Date• 474' <br /> CIWMB Approval: C&A ch Compliance <br /> CMM Closure and Retnedlation Branch(Rev.AM) <br /> Bond Approved(1!13/93) <br />