Laserfiche WebLink
SITE IDENTIFICATION FORM <br /> (Atuch additional description or explanation as needed.) <br /> Initial I.D. : Yes • Follow-up Investigation (YIN): <br /> SI'Z'E INFORMATION <br /> Site Name: / &✓.ejE,,�C v;E,eAl(o — .Ce 300 <br /> AKA: S ajE Roo - <br /> SWIS #: — _—County: s,4,5,meco (-)Parcel #(s): .25-1 info - as <br /> Location: <br /> (ImIude Location or 44una.map wAn Township, sage,and Section,Ana ParcelMap.) <br /> Land Owner(s): 'hiEA4-,eT-A6c_�OF F-6*e6,Z r c S 0VA e aM,eA r7 <br /> Address: <br /> City: State• Zip: Phone: <br /> 'Types of Waste: Inert Res., Com., Indust., Haz., Liquid <br /> �Dum m' Landfill, Burn Dump, Treatment Unit <br /> Site.Type: gal p g, <br /> Disposal Area (Acre): SWFP Date: WDR Number: <br /> Dates of Operations:_4 - Closure Approved By: <br /> LAND USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: r o <br /> Residential: Ya es No\ <br /> Commercial: Yea N Yes <br /> Industrial: Yes ea No <br /> Environmental Sensitive: Y No No <br /> Water Supply Wells: N <br /> Surface Water Bodies: es o es N <br /> Inhabitable Structures: Yes <br /> Enclosed Structures: Yes o o <br /> Planned Improvements: Yes No Yes No <br /> OBSERVATIONS <br /> Date of Field Visit: J Sig. Change Since Last Visit? (ylt/N ,JA) '`J14- <br /> Surface Condition: U E"�,�, �. � y �bi�� �4, ��� �6� �Im- �a4A <br /> Landfill Lias: <br /> Leachate: <br /> Other: <br /> . RECOMIVIENT)A`TION . <br /> Emergency Response: <br /> Other (e.g. man sane !Negri dumping that wsttsimts temovv):" <br /> Reassess Site? (YININA): No Further Action? (D Priority YIN): <br /> Priority for Site Asses t <br /> prepared gy: � 14 Date:- 4,7 q f:.•? -- <br /> CIWMB Approval: CddF ch Compliance <br /> CIWMB Closure and Remediation Branch(Rev.3!!0193) <br /> Board Approved"/93) <br />