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Site Identification Form (SIP) <br /> (See LEA Advisory No.3 -for Guidance) <br /> Initial LD.(Y/N) Y Date of Field Visit 5/25/11 Follow-up Investigation(Y/N) <br /> Site Information: <br /> Name Riverbank City Dump AKA <br /> County San Joaquin Nearest Town/City Riverbank <br /> Site Address 23707 S. Santa Fe Rd. SW-IS# 39-CR-0029 <br /> Zip 95367 APN 24726002 <br /> Latitude: _Degree Minute Second GPS <br /> Longitude: I Degree I Minute Second Map 4 <br /> Land Owner Information: 4 <br /> Land Owner Name City of Riverbank <br /> Address 6707 Third St. <br /> City Riverbank State CA Zip 95367 <br /> Phone Fax <br /> Site Specifications: <br /> Dates of Operations ' Closure Date - <br /> Closure <br /> ate -Closure Plan(Y/N)', Date of Closure,Plan <br /> Inspection Frequency I Quarterly Date;' 6/09/2011 <br /> Inspection Frequency Reduction Request(Y/N) N I Date of Request <br /> Wracking System Approved Date of Approval <br /> Site Type: 2136 Burn'Dump Illegal Dump Site Other <br /> Site Category: A I B I X J,Q D Category Date <br /> Surrounding Land Use: Commercial Residential Industrial X Other Wastewater <br /> Treatment Plant <br /> 71 <br /> Comments/Recommendations: <br /> EHD recommends increasing inspection frequency to quarterly in accordance with Title 14 Section <br /> 18083 (a) (4). <br /> LEA Staff Name I Benjamin Escotto Signature Date li <br /> CIWMB STAFFONLY: <br /> Reviewed By Date <br /> Enter In To SWIS By Date <br />