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EDENTIFICATION #RM <br /> (Attach additional description or explanation as needed.) <br /> Initial I.D. (YIN): Follow-up Investigation (Y/N): lel <br /> SITE INFORMATION r, ( ` <br /> Site Name: i Ueda bamv- AJ o <br /> AKA: <br /> SWIS #: County: S dag Cjv arcel As): <br /> Location:id-s o-r Sot�tz ,k"— <br /> tincue Location uwith Township,Range,,a 1�Section,an aree u <br /> map.) <br /> p <br /> Land Owner(s): C -"-2 - s_ -76r- <br /> Address: <br /> 7c Address: 2 3 ! 2 5- S. k y 12® a <br /> City: c,wt, -.-L —State:-UP—Zip: S"3 6 7 Phone: 2 Q 2 6 - 1 230. <br /> Types of Waste: Inert, es:, Com., Indust., Haz., liquid <br /> Site.Type: Illegal Dumping, Landfill, urn Dum Treatment Unit <br /> Disposal Area (Acre): 2- ox- SWFP Date: AM R Number: —V/ -- <br /> Dates of Operations: Dow—1 ® - Closure Approved By: VA &sv t�/ - <br /> LAND USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: No No <br /> Residential: No es No <br /> Commercial: es No es No <br /> Industrial:�d es No cgs No <br /> Environmental Sensitive: Yes. o Yes o <br /> Water Supply Wells: es No Yes No <br /> Surface Water Bodies: Yes o es No <br /> Inhabitable Structures: Yes No No <br /> Enclosed Structures: es No es - No <br /> Planned Improvements: Yes No Yes <br /> OBSERVATIONS <br /> Date of Field Visit: Ulc4Z _Sig. Change Since Last Visit? (Y ). <br /> Surface Condition: >1 o s* ased <br /> Landfill Gas: WIA <br /> Leachate: d 0-d <br /> Other. y ,cz- .5r a 6 aujs W kb"T% ���„�• <br /> ('69-7./® <br /> RECOMMENDATION <br /> Emergency Response: <br /> Other (e.g. small scale illegal dumping that warrants removal): ®7r <br /> Reassess Site? (Y/N/NA): so No Further Action? (D Priority Y <br /> Priority for Site sessment (xi 1Medtl,ow): 46 V�j <br /> Prepared By: L Date: <br /> CIWA1B Approval: CA Branch Compliance . <br /> CIWMB Closure and Remediation Breach(Rev.3710093) <br /> Board Approved(2125/93) <br />