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S:. E FiCATION F*q <br /> (Attach additional description or explanation as needed.) <br /> Follow-up Investigation ("YIN): <br /> Initial I.D-(�9 <br /> SITE INFORMATION <br /> Site Name: 9HC. LonhssmAg= LEA­'-,!A-26;64 ,41'7_ <br /> AKA: 263 - lt3o--12- <br /> SWIS #: County: u® Parcel #(s): - > -®! C P � <br /> Location: . s'- r- e-vZ - t 7-3Stin <br /> cue Location or uaMap tvitty 1,ownsaip,Range,and Secdon,and FamalMap. <br /> Land Owner(s): <br /> Address: 0- .60 <br /> City:_ ,.J State: Zip: Phone: C a0�7 <br /> Types of Waste: •Ina Res., Com., Indust., Haz., Liquid <br /> (Jt o�of �r <br /> Site.Type: Illegal Dumping, Landfill, Burg Dump, Treatment Unit ,t t e t <br /> Disposal Area (Acre): - SWFP Date: WDR Number: -� <br /> Dates of Operations: u �-t Closure Approved By: a�•e <br /> oq <br /> LAND USE ON OR WrrB11N 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: Yes 1 No Y No <br /> Residential: Yes No Yes No <br /> Commercial: No M No <br /> Industrial: Mo Yes No <br /> Environmental Sensitive: Yes No Y No <br /> Water Supply Wells: Y No Y No <br /> Surface Water Bodies: Q No No <br /> Inhabitable Structures: No es No <br /> Enclosed Structures: Yes No <br /> Planned Improvements: Yes/"'No Yes No <br /> OBSERVATIONS <br /> Date of Field Visit: 2- q-3 Sig. Change Since Last Visit? (Y r/NAA1 �. <br /> Surface Condition: r_/", 0,/ <br /> c <br /> Land Gas: <br /> Leachate: , !s <br /> Other: , A-1 J2-1 ! <br /> RECOMMENDATION <br /> Emergency Response: <br /> Other (e.g. small scale illegal dumping that warrants removal): <br /> Reassess Site? (YININA): No Further Action? (D Priority Y/N): <br /> Priority for Site As ant hiMed/Low): <br /> Prepared By: Ff-� Date: <br /> CIWN1B Approval: ranch Compliance <br /> CtwMB Closure and Remediation Branch(Rev.A'0/93) <br /> Board Approved(2!2$/93) <br />