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., <br />AFE IDENTIFICATION FGAM <br />(Attach additional description or explanation as needed.) <br />Initial I.D. (Y/N): y <br />SITE INFORMATION <br />a <br />Follow-up Investigation WIN): <br />Site Name: ✓!- t. v a 4- �e- 1/ wm je <br />AKA: <br />SWIS #: County: S a Parcel #(s): <br />Location: 2 `l2 `f 7 <br />Land Owner(s): (r p a K. d e- '�- <br />Address: 2 41 2 Y 7 7-A o <br />City: T% o .fro A-2 State: G4' Zip: ?a 6' Phone: .2- 01- 7 2Y 2 Y Y 7. <br />Types of Waste: <io es., Com., Indust., Haz., Liquid <br />Site Type: Illegal Dumping, (L�iO Bum Dump, Treatment Unit <br />Disposal Area (Acre): a e v4.c. SWFP Date: WDR Number: <br />Dates of Operations: 17 Y 7 - S' 7 Closure Approved By: <br />LAND USE ON OR WITHIN 1000 FT 1 MILE OF WASTE BOUNDARY <br />Rural: <br />Residential: <br />Commercial: <br />Industrial: <br />Environmental Sensitive: <br />Water Supply Wells: <br />Surface Water Bodies: <br />Inhabitable Structures: <br />Enclosed Structures: <br />Planned Improvements: <br />OBSERVATIONS <br />Y No Yes No <br />es No (53 No <br />Date of Field Visit: '_Sig. Change Since Last Visit? (YIN/NA): /U <br />Surface Condition: �- - / C Z. ,u_, <br />Landfill Gas: .! lc <br />Leachate: LA le - <br />Other: <br />RECOMMENDATION <br />Emergency Response: ��1 <br />Other (e.g. small scale illegal dumping that warrants removal): <br />Reassess Site? (YIN/NA): No Further Action? (D Priority Y/1): <br />Priority for Site Ass ssment (High/Med/Low): L- o c j <br />Prepared By: Date: <br />CIWMB Approval: C&R Branch Compliance <br />CIWMB Closure and Remediation Branch (Rev. 3710/93) <br />Board Approved (2125/93) <br />