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IDENTIFICATION AbAl <br /> (Attach additional description or explanation as needed.) <br /> r <br /> Initial I.D. Follow-up Investigation (Yr : <br /> SITE INFORMATION <br /> site Name: 1®x,6\/ 0 td6J.s 0"'2"'1 <br /> AKA: <br /> SWIS #: County:SAj Parcel #(s): z9f-!�-06 <br /> Location: F_ rs A✓� She. , r.S �f H <br /> cue ua aao or .map withow ip,Range, Section,an arcatip. <br /> Land Owner(s): " ,es g4 •`r® •-2G2_v� <br /> Address: Jogg &J zVb <br /> City: r State: Zip: Ph�20ql-,7304,Types of Was InaRes., Com., Liquid <br /> Site.Type: H Megal Dumping, Landfill, Bum Dump, 'treatment Unit <br /> Disposal Area (Acre): -/0 SWFP Date: WDR Number: <br /> Dates of Operations: e&=d ® °e-6 Closure Approved By: <br /> LAND USE ON OR WITHIN 1000 IT 1 NBLE OF WASTE BOUNDARY <br /> Rural: <br /> Yes No Yes No <br /> Residential: Yes No Y No <br /> Commercial: Y No Yes No <br /> Industrial: Yes Yes No _ <br /> Environmental Sensitive: Yes N Y_ No <br /> Water Supply Wells: Yes No Yes No <br /> Surface Water Bodies: Yes KNo `Yes) No <br /> Inhabitable Structures: Yes No Yes No <br /> Enclosed Structures: Yes No Yes No <br /> Planned Improvements: Yes No es No <br /> OBSERVATIONS <br /> Date of Field Visit: 3 Sig. Change Since Last Visit? (Y INA <br /> Surface Condition: _c- s e.e . <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOMMENDATION <br /> Emergency Response: <br /> Other (e.g. small scale illegal dumping that warrants removal): <br /> Reassess Site? (Y/N/NA): No Further Action? (D Priority YIN): <br /> Priority for Site As en t gh1Med/Low): <br /> Prepared By: let <br /> Date: <br /> CIWN[B Approval: ranch Compliance <br /> CIWMB Closure and Remediation Branch(Rev.37!0193) <br /> Board Approved(ZJ25/93) <br />