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✓ p <br /> C- <br /> ,�� ATTACHMENT 3 <br /> SITE ASSESSMENT DATA FORM <br /> (Attach additional description or explanation as needed <br /> or include in comment Section VII.) <br /> I. DISPOSAL SITE CHARACTERISTICS <br /> A. Waste Area(s) Dimensions <br /> 1. Area and Volume (acre and yd3): C/4 <br /> 2. Estimate Maximum Depth of Waste (ft): -� w <br /> 3. Estimate Average Depth of Waste (ft): <br /> B. Soil Type (check appropriate soil type) <br /> Nati Cove <br /> 1. Clay, silt, loam (low permeability): �/ <br /> 2. Sand, pebble (medium permeability): <br /> 3. Gravel, cobble, rocks (high permeability): <br /> C. Mean annual precipitation (in): 1� 2-Year 24-Hour (in): <br /> D. Estimated separation between waste and groundwater (ft): <br /> E. Is waste area within a 100 year flood plain? (Y(9. 1 <br /> F. Show the following items on a site map(s): <br /> 1. Property boundaries <br /> 2. 'Taste disposal area(s) boundary <br /> yPs, c_ 3. Structures on or within 1000 ft. of waste <br /> 4. Topographical Contours <br /> ? a `� 5. Access points and roads v(� �' ° t`'> <br /> 6. Site security systemsE-- <br /> 7. Surface water bodiea and drainage patterns i--o <br /> 8. Monitoring and control systems t- 4, <br /> 9. Areas where landfill gas migration was detected <br /> 10. Areas where leachate migration was detected <br /> yet c.►-f-� w-C w', <br /> G. Provide a chronological list of enforcement actions for the site <br /> ZI S V b <br /> l4 fe t t--!/ r�+ �2- ��1� S-�/�w�. r*d s'r t N �� S i L,► r^C:w. e,., ee a. /° <br /> / F �„.- > '1 �+ + l'✓s«,6 G^k, �ir fc.-. 6-"'C44 6/11;-;, <br /> +bra <br /> Page 1 of 4 <br /> CIWMB Closure and Remediation Branch (1/25193) <br />