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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 or P'W�� <br />1. Area and Volume (acre and yd3): -F 1r l6 0 `F°� <br />2. Estimate Maximum Depth of Waste (ft): d- <br />3. Estimate Average Depth of Waste (ft): 3 t <br />B. Soil Type (check appropriate soil type) <br />Native Cover <br />1. Clay, silt, loam (low permeability): c- 41-0- eA-k" <br />2. Sand, pebble (medium permeability): <br />3. Gravel, cobble, rocks (high permeability): <br />C. Mean annual precipitation (in): 2 -Year 24 -Hour (in): <br />0. Estimated separation between waste and groundwater (ft):.� _��' 414- <br />E. - <br />E. Is waste area within a 100 year flood plain? (Y/N): <br />F. Show the following items on a site map(s): <br />1. Property boundaries <br />2. 'Haste disposal area(s) boundary <br />3. Structures on or within 1000 ft. of waste <br />4. Topographical Contours <br />5. Access points and roads <br />6. Site security systems <br />7. Surface water bodies and drainage patterns <br />8. 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 actions for the site , <br />No,.�L <br />Page 1 of 4 <br />CIWMB Closure and Remediation Branch (1/25193) <br />