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Site Identification Form (SIP) <br />(See LEA Advisory No. 3 - for Guidance) <br />Initial I.D. (Y/N) I Y Date of Field Visit 5/25/11 Follow-up Investigation (Y/N) <br />Land Owner Information: <br />Land Owner Name City of Escalon Public Works <br />Address 2103 Main St. 1 <br />City Escalon State I CA Zip 95320 <br />Phone Fax <br />Site <br />Site Specifications - <br />Dates of Operations Closure Date <br />Closure Plan (Y/N) N Date of Closure Plan <br />Inspection Frequency, Quarterly Date —T6/09/2011 I <br />Inspection Frequency Reduction Request (Y/N), N I Date of Request, <br />Tracking'5ystem Approved Date of Approval <br />Site Type: ,,' 2136,1�,Burn Dump, "legal Dump Site Other" <br />B X Cateegory Date <br />Site Category: A <br />Surrounding',Lan Use: inComerci Residential Industrial I X Other Wastewater <br />, Id <br />Treatment Plant <br />Comments/ Recommendations: <br />EHD recommends increasing inspection frequency to quarterly in accordance with Title 14 Section <br />18083 (a) (4). <br />LEA Staff Name I Benjamin Escotto 'Signatur:e:ate <br />M <br />M <br />Reviewed By Date <br />Enter In To SWIS By Date <br />