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C"' <br /> SITE IDENTIN A. ON OfA4 <br /> (Attach additional description of explanation 85 needed.) <br /> Initial I.D. (Y/N): Follow-up investigation (Y/N): <br /> SITE INFORMATION <br /> ,, <br /> Site Name: Al— .4 <br /> AKA: 7 s-0 ")_0 al-t Cma <br /> SWIS #: County: -1��Parcel #(s): <br /> Location: <br /> (1—ncluacE.5csoon or uah 'ain-a-S—ection,and Parcel <br /> AA_ a-t+i� J <br /> Land Owner(s): <br /> UC �37 <br /> Address: SO 1. Six Phone:City: T_1:y_'-"'1,,oa_ State:__(:�-_1Zip: L70akd-- pho <br /> d <br /> Types of Waste: InertHsi Liquid Res., Com., =e� <br /> Site.Type: Illegal Dumping, dfilT Burn Dump, Treatment Unit <br /> Disposal Area (Acre):______;—__SP Date: WDR Number: <br /> Dates of Operations: Closure Approved By: <br /> LAND USE ON OR WITHIN _10_0_0_ZE---1—MILE­ OF WASTE BOUNDARY <br /> Rural: Yes No Yes o <br /> 4 — ('Y� No <br /> Y No <br /> Residential: 1�� <br /> 40 <br /> Commercial: y No r-Y_� No <br /> N <br /> Industrial: fes No No <br /> Environmental Sensitive: No <br /> No A K 0 <br /> Water Supply Wells: es <br /> No No <br /> Surface Water Bodies: es Noes' No <br /> Inhabitable Structures: es <br /> Enclosed Structures: &-a No No /0/4' <br /> Planned Improvements: 4-0 1- <br /> OBSERVATIONS <br /> Date of Field Visit:_L1_/1_/_q_"4—' Sig. Change Since Last Visit? (Y4@)KA)- <br /> Surface Condition: <br /> Landfill Gas: <br /> Leachate: <br /> Other: <br /> Emergency Response:-- <br /> Other (e.g. small scale illegal dumping that warrants removal): A-1 0 <br /> Reassess Site?(O/NINA): No Further Action? (D Priority <br /> Priority for Site.Assessment (ffigbjMed/Low)*_ <br /> 2 <br /> Prepared By: Date: 6 <br /> C1WN[B Approval: C&R Branch Compliance <br /> ctwmB closure and Remediation Branch(Rev.3f 10193) <br /> Board Approved(2t25/93) <br />