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S EIS PO4 <br /> (Attach additional description or explanation as needed.) <br /> Initial I.D. (Y : YES Follow-up Investigation (Y/N).- <br /> SITE <br /> Y/N):SITE INFORMATION <br /> Site Name: .-i <br /> AKA: EScAhp A)C MY� / L- <br /> SWIS #: - tt County:_ _ rtf Parcel #(s): 4-7 -- o— <br /> Location: ;Z51co F. x i v o^) 17Y-20 - <br /> (Include Location o uad.Map w i ®map',Rang,an "Section,an atcc ap. <br /> Land Owner(s): cf s c Go ,ate f f c <br /> Address: 0 - 6G)c 4 <br /> City: Es L-Q State: CA Zip: S 2_ Phone: C a F-38-357814 <br /> Types of Waste: Inert, Res., Com., Indust., Haz., L.iqui <br /> Site.Type: Illegal Dumping, Landfill, Bum Du Treatment Unit <br /> Disposal Area (Acre): -10 SWFP Date: WMR Number: <br /> Dates of Operations: C[ / Closure Approved By: <br /> LAND USE ON OR WI'I°FiIN 1000 FT 1 MILE OF WASTE BOUNDARY <br /> Rural: IQ No Yes No <br /> Residential: Y No eYes No <br /> Commercial: Yes Nb ?YZ No <br /> Industrial: Y e s CN-01 No <br /> Environmental Sensitive: Y No Y No <br /> Water Supply Wells: Y No Yes No G v. � � <br /> Surface Water Bodies: _Yes o Yes No <br /> Inhabitable Structures: Yes No Yes No <br /> Enclosed Structures: es o Yes No <br /> Planned Improvements: Yes No Yeses No <br /> OBSERVATIONS <br /> Date of Field Visit: 3 If 9 Sig. Change Since t Visit? (Y NN <br /> Surface Condition: <br /> IF <br /> Landfill Gas: <br /> Leachate: <br /> Other: - <br /> RECOADUNDATION <br /> Emergency Response: <br /> Other (e.g. small scale illegal dumping that warrants removal): <br /> Reassess Site? (Y/NINA): No Further Action? (D Priority Y/N): <br /> Priority for Site,A meet hiMed/Low): <br /> Prepared By: 9k ate: 31� <br /> CIWNIB Approval: ranch Compliance <br /> C1 ^0 Closure and Re iation Branch(Rev.3710/93) <br /> Board Approved(2125/93) <br />