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SIDE ]EDENTNICATION F <br /> (Attach additional description or explanation as needed.IV <br /> Initial I.D. (YN: Follow-up Investigation (YIN): <br /> SITE INFORMATION <br /> Site Name: 644-- <br /> AKA: "AKA.: <br /> SWIS #: -Iq- A-60 B County: lay 6✓nr-4 Parcel #(s): <br /> Location: fess 4- �fm �4 - l se, Zq I; /-Al .� -E P' <br /> �Incue Locauon or Quad-78–p—w—IM TownshlP,Rauge,and Secuon,an arce 1110. <br /> Land Owner(s): Ai <br /> Address: 10s , sarr <br /> City: _State: Zip: 4 5- Phone: C� ) qd� — l P <br /> Types of Waste: e Res., Com., ui 4-As <br /> x`21 <br /> Asb <br /> dfill, Bum Dump, Treatment Unit s�° <br /> Site.Type: Illegal Dumping, P <br /> Disposal Area (Acre): &P"x A SWFP Date: WDR Number: 7 q"-3,6 3 s <br /> Dates of Operations: 675 'A /-2 "Closure Approved By: Co—ScA 4, 7C,- 117 <br /> LAND USE ON OR WITHIN 1000 1 NIILE OF WASTE BOUNDARY <br /> Rural: Yes o es No <br /> Residential: _es No es <br /> Commercial: es o No <br /> Industrial: Y No No <br /> Environmental Sensitive: Yes o Yes No -- ss1biy e <br /> Water Supply Wells: Yes No Yes No <br /> Surface Water Bodies: Yes No Yes No <br /> Inhabitable Structures: Yes No Yes No <br /> Enclosed Structures: Yes o Yes No <br /> Planned Improvements: Yes No Yes No <br /> OBSERVATIONS <br /> Date of Field Visit: Sig. Change Since Last Visit? (Y/N/NA): <br /> Surface Condition: <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> RECOACYIENDATION <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 Y/N): <br /> Priority for Site.Assessment (MghlMed/Low): <br /> Prepared By: Date: <br /> CIWMB Approval: C&R Branch Compliance <br /> Cr*UB Closure and Remediation Branch(Rev.3710/93) <br /> Board Approved(2M/93) <br /> J <br />