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N Z,04,-� 704P 7i-0-c7f * ATTACHMENT 3 <br /> 94 cam; IFW <br /> SITE ASSESSMENT DATA FORM_ <br /> (Attach additional description or explanation as needed <br /> or include in comment Section <br /> .j <br /> I. DISPOSAL SITE CHARACTERiSTIA' """4 <br /> A. Waste Area(s) Dimensions y old 000 Y cf <br /> 3 <br /> r - <br /> 1. Area and Volume (acre and yd3): 2 <br /> 2. Estimate Maximum Depth of Waste (ft): to �s ' <br /> 3. Estimate Average Depth of Waste (ft): <br /> B. Soil Type (check appropriate soil type) <br /> Native Cover <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): 2-Year 24-Hour (in): Z-7 - <br /> D. Estimated separation between waste and groundwater (ft): <br /> E. Is waste area within a 100 year flood plain? (Y& zfs .� .se4 /: W ' <br /> 1"4e ae.,) /r le AV, <br /> F. Show the following items on a site map(s): <br /> 1. Property boundaries <br /> 2. 'Haste disposal area(s) boundary .S ; <br /> 3. Structures on or within 1000 ft. of waste No►-a- <br /> 4. Topographical Contours <br /> 5. Access points and roads <br /> 6. Site security systems <br /> 7. Surface water bodies and drainage patterns <br /> B. Monitoring and control systems <br /> 9. Areas where landfill gas migration was detected <br /> 10. Areas where leachate migration was detected <br /> G. Provide a chronological list of enforcement a4ion�s for he Site <br /> 01 � /,p 41-5 � y <br /> c u s5 A"C uTl;-- <br /> Ps%e 1 of 4 <br /> C1WMB Closure and Remediation Branch (1125 93) <br />