Laserfiche WebLink
t1 <br /> SI'Z'E IDEN'TIFICA'TION FORM <br /> (Attach additional description or explanation as needed.) <br /> Initial I.D.(90 Lifs Follow-up Investigation (Y/1): <br /> SITE INFORMATION <br /> Site Name: LA-,.✓.2JEN2QQC LI(IZAe A160Ae — c ,72E 3Q <br /> AKA: T r`ri. J <br /> SWIS #: -___County: s,4•j.�r4f,.)u,�Parcel #(s): <br /> Location: /Tq 9, r.�� rnQ.B,4L."-&-) -'r"c, <br /> na er e <br /> (Include Location O! map Want Ow'11!<mp.,icauae,anw Section,was ParcelMap.) <br /> Land Owner(s): iEy_K96,X . u• S. C�✓f.e,✓� .✓7- -- <br /> Address: <br /> City: State:—Zip: Phone: <br /> Types of Waste: tj!ggd��11111 <br /> Res., Com., Indust., Hsz Liquid <br /> Site T bum in , Landfill, Burn bump, Tmatnient Unit <br /> . yI� p B <br /> Disposal Area (Aare): SWFP Date: WDR Number: <br /> Dates of Operations: 02ry — 018'r-, Closure Approved By: <br /> LAND USE ON OR WITHIN 1000 FI' 1 MII.E OF WASTE BOUNDARY <br /> Rural: ;' No Y�) o <br /> Residential: as Yes <br /> Commercial: Yea Yes <br /> Industrial: es <br /> Environmental Sensitive: o Y No <br /> Water Supply Wells: Yes No es N <br /> Surface Water Bodies: Yes o es o <br /> Inhabitable Structures: Yes 0 Yes o <br /> Enclosed Structures: g o es <br /> Planned Improvements: Yes No Yes No <br /> OBSERVATIONS <br /> Date of Field Visit: i(, q3 Sig. Change Since Last Visit? (Y/INA ) <br /> Surface Condition: -h) ,. � f ,fes �x�ins,� r Ae A.6 <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOM BNDA'TION <br /> Emergency Response: <br /> Other (e.g. #mall sale Meg-it dumping that warr#nt# removal):' <br /> Reassess Site? (YININA): No Further Action? (D Priority Y": <br /> Priority for Site Assess t #throw): <br /> Prepared By: KS Date• t 4 FJ <br /> CIWMB Approval: Cn4hadch Compliance <br /> CIWMB Cloture and Retnediadon Breach(Rev.3710/93) <br /> Board Approved(?!2S/93) <br />