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A <br />�YJ ATTRC 'VLENT 3 <br />SITE ASSESSMENT DATA FORM Jr, <br />(Attach additional description or explanation a <br />or include in comment Section ; zr <br />I. DISPOSAL SITE CHARACTERISTICS <br />A. Waste Area(s) Dimensions <br />1. Area and Volume (acre and yd3): P, -7 �c 1" c <br />2. Estimate Maximum Depth of Waste (ft): Ire u�N w �1 <br />3. Estimate Average Depth of Waste (ft): %, k <br />B. Soil Type (check appropriate soil type) <br />Native Cove <br />1. Clay, silt, loam (low permeability): <br />2. Sand, pebble (medium permeability): <br />3. Gravel, cobble, rocks (high permeability): <br />C. Mean annual precipitation (in): / % 2 -Year 24 -Hour (in): P, 7h AA <br />D. Estimated separation between waste and groundwater (ft): -+k Irk <br />E. Is waste area within a 100 year flood plain? (Y/N): /�«�-�✓`� <br />F. Show the following items on a site map(s): <br />1. Property boundaries <br />2. Waste disposal area(s) boundary <br />3. Structures on or within 1000 ft. of waste` "f <br />4. Topographical Contours r ---r" <br />5. Access points and roads <br />6. Site security systemsc,- <br />7. Surface water bodies and drainage patterns <br />S. Monitoring and control systems <br />— Areas where landfill gas migration was detected <br />10. Areas where leachate migration was detected <br />G. Provide a chronological list <br />r!r'f7/l7t'I <br />enforceme�n/t� actions for the site <br />iag ".a EJ1 eg"n s7 �tK�`�on k) A S <br />/, ., .:.� ✓� �i �A/tom. I-,. cc> - �$ <br />Page 1 of 4 <br />ClWMB Closure and Remediation Branch (1/2593) <br />