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*ATTACHMENT 2 <br /> SITE IDENTIFICATION FORM <br /> (Attach additional description or explanation as needed) <br /> INITIAL I.D. (Y/N).- FOLLOW-UP INVESTIGATION (Y/N): A) <br /> SITE INFORMATION <br /> SITE NAME: -f C01/?CIY'dz!- <br /> AKA: <br /> �JSL- �PRARCQE��#(s): 63 <br /> SWIS 4: COUNTY: 5�ln Joaq,101 Z6 <br /> LOCATION: eRW a). . 5AD&M <br /> (include Location or Quad. Map with T wnshiP /R <br /> pge��nn <br /> Section, and Parcel Map) <br /> LAND OWNER�p): <br /> ADDRESS- <br /> CITY. 6/ STATE:_C 41P: 91 73'1- PHONE: <br /> TYPES OF WASTE: INERT, RES., COM., INDUST., HAZ., LIQUID <br /> SITE TYPE: ILLEGAL DUMPING, LANDFILL, BURN DUMP, TREATMENT UNIT <br /> DISPOSAL AREA (ACRE): I SWFP DATE: WDR NUMBER: <br /> DATES OF OPERATIONS: —CLOSURE APPROVED BY: <br /> LAND USE ON OR WITHIN OF WASTE BOUNDARY <br /> RURAL- Y <br /> RESIDENTIAL: YE E N <br /> COMMERCIAL: <br /> INDUSTRIAL: <br /> ENVIRONMENTAL <br /> TAL SENSITIVE: YES YES N_-0) <br /> WATER SUPPLY WELLS- Y EO NO <br /> SURFACE WATER BODIES: -- NO <br /> INHABITABLE STRUCTURES: E NO E NO <br /> ENCLOSED STRUCTURES: <br /> PLANNED IMPROVEMENTS: YEs9 <br /> OBSERVATIONS /n <br /> /p q3 NCF LAST VISIT? (Y/N <br /> DATE OF FIELD VISIT: 0' SIG CHANGE SI /NA) <br /> — <br /> SURFACE CONDITION: 191911ye9l _rr, 1) 011Wff k7af <br /> LANDFILL GAS: <br /> LEACHATE: elow__ ab_krz <br /> OTHER: <br /> RECOMMENDATION <br /> EMERGENCY RESPONSE: <br /> OTHER (e.g. small scale Illegal dumping that warrants removal): <br /> REASSESS SITE? (Y/N/NA): _tj—NO FURTHER ACTION? ( PRIORITY Y/N): <br /> M — <br /> PRIORITY FOR SITE 4SSESS T (High/Med/Low): 60it) <br /> PREPARED BY. .<3 I Aeaz�f-' T'SS5_.11_ - DATE: i2_�lz <br /> CIWMB APPROVAL: C&R BRANCH COMPLIANCE <br /> clWMB closure and Remediation Branch (1/25193) <br />