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SW <br /> EDENTTFICATION <br /> (Attach additional description or explanation as needed. <br /> Initial I.D. (Y/N); Follow-up Investigation (Y/1): <br /> SITE INFORMATION <br /> Site Name: O rT9 or 1r2Ac-V LAS 11- <br /> AICA: <br /> SWIS #: County:SAM JOAGLLA r,I Parcel #(s): -LLVIL,-ob o 25"3'a30-2� <br /> Location: SE do AVIC OF e& L 40L,1-0 0. aoof IWE r '3`60kin . <br /> cue Locauon <br /> or ua map wt ow ip, ange, ecuon,an arca Map. <br /> Land Owner(s): m -J-,A �,r� Com AjTq l to.f-1 AceEs 4 q '006,tc, <br /> Address: AK P x 1 O .sA] <br /> City: S-t vc.ic zo kl _State: c, 7 p: Phone: (A <br /> Types of Waste: Inert, Res., Com., Indust., Haz., Liquid <br /> Site.Type: Illegal Dumping, Land Bum Dump, Treatment Unit <br /> Disposal Area (Acre): ry .SWFP Date: WDR Number: <br /> Dates of Operations: 1%2-- 11 Closure Approved By: <br /> LAND USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: Yes (No) Yes No <br /> Residential: Yes No Yes No <br /> Commercial: Yes o Yes No <br /> Industrial: Yes No Yes No <br /> Environmental Sensitive: Yes Yes No <br /> Water Supply Wells: Yes No Yom_No <br /> Surface Water Bodies: Yes N45N Yes No <br /> Inhabitable Structures: Yes No Yes No <br /> Enclosed Structures: Yes No Yes No <br /> Planned Improvements: Yes o Yes No <br /> OBSERVATIONS <br /> Date of Field Visit. 9 Sig. Change Since Last Visit? (Y/N/NA): NA <br /> Surface Condition: osti ble jawd 5e8h O Obxe✓v&t rf-Pu, c� r <br /> Landfill Gas: Ung r) kl&Y-ee 4-,` � . <br /> Leachate: k)Loowo tIa ohs we <br /> Other: <br /> RECOMMENDATION <br /> Emergency Response: - <br /> Other (e.g. small scale illegal dumping that is removal): <br /> Reassess Site? (Y/N/NA): No Further Action? (D Priority Y/N): <br /> Priority for Site.Assessment (EghiMed/Low): <br /> Prepared By: .J Date: 3- 0 f <br /> CIWN33 Approval: C&R Branch Compliance <br /> CPKMB Closure and Remediation Branch(Rev.3710/93) <br /> Board Approved"M) <br />