GAYE EGG FARM UNION CO_MISC_20171231

- - w
Control Number
County Number
GROUNDWATER POLLUTION SOURCE INVENTORY
049
Source Name
OWNERSHIP
a
Private
2 Municipal
Source Address
0J7,2?e7 S• 51dto
5
m� Sg
SQ
3 County
4 State
City
County
Region
v� IIQ-
1 !11
5 Federal
6 Military
Owner/Operator
b Quad Narne
I;ulti urces at site
coun y Source Vs
YES NO
POTENTIAL SOURCE OF GROUNDWATER POLLUTION
LOCATION
OPERATION TYPE
TYPE OF WASTE
DISPOSAL FACILITY
OTHER SOURCE
®1 Facility
I Municipal
1 Gasoline/diesel
Lagoon, etc.
1 Agricultural Activity
2 Highway
2 Industrial
2 Other oil
2 Landfill-contro.
2 Salt water intrusion
3 Railroad
3 Agricultural
3 Solvents
3 Landfill-uncont.
3 Chemical stock pile
4 Waterway
4 Oil and gas
4 Corrosives
4 Land application
4 River infiltration
5 Pipeline
5 Mining
5 Other chemical
5 Abandoned site
5 Mine drainage
6 Dumpsite
Other Source
6 Sewage/septage
6 Sewer system
6 Intentional dump
7 Other
7 Sludge
7 Septic tank
7 Spill
8 Leachate
8 Injection well
8 Leak --above ground
a9 Other solids
9 Disposal well
9 Leak --underground
�In use
STATUS OF
10 Gas
WASTE: �o of }l LtlQS G
SOURCE: 2 Inactive
11 Pest/herbicides
3 Other
12 Fertilizers
POLLUTION STATUS AND CROSS-REFERENCES
GROUNDWATER POLLUTION
FACILITY PERMITTED: Yes No
1 Confirmed I) Rank
1 NPDES
6 Mining
0 Potential 2 Tabulate
No:
2 DEM Nondischarge
No:
7 Hazardous Waste (RCRA)
MONITORING WELLS
No:
No -
1 No monitoring
2 State has data
3 Well Construction
8 Solid Waste (Landfill)
3 Data at facility
No:
No:
Status unknown
4 Capacity Use
9 Oil Terminal Registration
DATABASE CROSS-REFERENCE
No:
No:
1 £RRIS (CERCLA) list
5 UIC
0 Air Quality
ID:
No:
No:
2 Surface Impoundment (SIA)
Comments Ctm �hQd Za joo"s 4, 360„ ft) J, 39he 811 deep
3 /, �%+I /fie 9' deep
3 GW Pollution Source Inv.
#1/ 0.7? g'dref
Date:
#S D, 77 he S`elowf>
,d J 0, 77 he 8' 4WfP
4 Other DEM investigation
Date:
Compiler:
Date.

If , 1 0" FORM APPROVED
d1,1'r,
/>,.'i k) OMB NO. 158-578004
DATE PREPARED
U.S. ENVIRONMENTAL PROTECTION AGENCY
SERIAL NUMBER
MONTH - DAY YEAR AIR
SURFACE IMPOUNDMENT ASSESSMENT (SIA)
LOCATION AND COUNT OF IMPOUNDMENTS
10
llo
q
SECTION I
13�
79
7S 76 77 78 80'
FACILITY IDENTIFICATION
How many impoundments are STATE IDENTIFICATION NO. (Optional)
STATE CNTY./CtTY PLACE CATEGORY SIA SITE NUMBER
located a t this site?
19 41
11
t,,
I 9L
A
IC,,l
1,71-5
.
PJ
r
0,
......
1 2 3 5 6 10 11 13 14 18
22
L
23 2.5 26 37
STANDARD INDUSTRIAL
SITE LOCATION
NPDES NUMBER
CLASSIFICATION (SIC Code)
rjfC;REES MINUTES SECONDS 'NU -1
LATITUDE
TUD
LONGIT UD
�lrco";
38 46 50
47 -
nAx [jEZM 5 1 52 53
7 54 62 63
OWNER
NAME OF OWNER
2
1 F1 h 1
101
1
1 1
1
1 1
1
1
1 1
1 1
LF
I I
I
I
I
I
ITI
2
OWNER'S MAILING ADDRESS (Street No. or P.O. Box)
f;
I cd-
I Rn
-�-
I
1
11
1
1
1
1
1 1
1
1
1
1
1 1
1 1
1
1
1
1
1
L
I
L-1
I I
.1
22 59 F.
CITY OR TOWN
STATE
ZIP CODE
LL
I J
I I
I
1
2 0
,,1:
2.
22 52
53 54
55 59
OPERATOR
NAME OF OPERATOR
=iji
I I cm
LtA
Li
I F-
-F
22 59
OPERATOR'S MAILING ADDRESS (Stree4l No. or P.O. Box)
I Mir
-
J
I
I
I
I
I
22 59
CITY OR TOWN
STATE
ZIP CODE
22 52
153 54
55 9
EPA Form 7500-44 (6-78) STATE COPY

GROUND WATER DIVISION
OFFICE OF MATER AND AIR RESOURCES
DEPARTMENT OF NATURAL AND ECONOMIC RESOURCES
RECORD OF GROUND WATER POLLUTION SOURCE
i
cn S 9
el -
moa !8' So"
RECORD
BY:
DATE 0170171
W.D. PERMIT NO.
TOWN:
CLAMD FILL, LAGOOM, ETC)
COUNTY:
IA
LOC%-'.`; 10N
(SKETCH ON
BACK): o• I r� '. E•
Qf ST 1728 ori
S- sada ar s� 1735 (Sao'
OWNER(S) OF
FACILITY OR INSTALLATION:
TYPE SOURCE:
CLAMD FILL, LAGOOM, ETC)
CHARACTER AND QUANTITY OF POLLUTANTS:
GZ,'C-h--.
74r-,
DESCRIPTION
OF FACILITY CSKETCH ON BACK) -.Z,,4
o�+ #/
/Fn'
x 3-3I G' $ ��•39N<+•
In
���� x ,�g �X �' ��.f ��Y cam
/7GV r P(0.77
.3
Y 77rfc..
HYD OG=OLOGIC CONDITIONS AT SITE:
POLLUTIOfN CONFIRMED BY ANALYSIS? DATE ANALYST:
MONITORING FACILITIES INSTALLED:
Si4' I C SCHEDULE:
NEAREST STREW,: 47- ��il✓cKi7.4r`i ['rcek DISTANCE moo'
NEAREST WATER SUPPLY WELL: k, DISTANCE .Soo'
ANALYSES AND OTHER DATA AVAILABLE:
j� d x 32,
7
rokr —c't i.' - 4 -

•
G R 0 U N D W A T E R, POLLUTION SOURCE EVALUATION
RANKING CRITEP.IA
THREAT TO GROUNDWATER
Probability of Groundwater Violations
! 3 / Violations documented or highly probable
2 Default
1 Violations unlikely .
E t of Groundwater Contamination
3 Mappable,'migrating plume
2 Default
I Insignificant contamination expected
Seriousness of Groundwater Threat
3 One of most serious in DEM region
2 Default
Not considered a serious problem
O FEASIBILITY FOR TAKING ACTION
Feasibility for Remedial Action
/ 3 J Remedial action both feasible and desirable
2 Default
1 No remedial action recommended
Desirability of Remedial Action
One of top regional office priorities
2 Oaf au It
I Not a priority incident
J-- THREAT TO PEOPLE OR ECONOMY
How Hazardous to Health/Economy
3 People or business advised of contamination
l_/ Default
1 No expected impacts on people or business
Number of People at Risk
3 4 or more family units, or $10,000 loss
/Z 1 Default
1 No people or other interests at risk
Seriousness of People Threat
3 Strong OEM concern over threat to people
Default
1 No threat to people or economy
FEASIBILITY OF RECLASSIFYING GROUNDWATER
Need -to Rec]assifv Croundwater
3 Groundwater should be relassified RS or GC
Default
1 No reclass. nor remedial action recommended
Desirability of Reclassification
One of top reclassification priorities
2 Default
1 Not a priority incident
i� THREAT OF POLLUTANTS
How Toxic are Pollutants (use Sax)
3 High value
0 Mod value
1 Low or None value
Quantity of Pollutants in Ground
3 Reportable quantity of hazardous material
(CERCLA def.) or quantity of real concern
2) Default
1 Not of concern to regional office
Seriousness of Pollutant T"rest
3 One of most serious in DEM region
ODefault
1 Not a serious threat
RANK SCORE:
Source e:
Control Number:
County: 1/su r
Ranker:
Date:

III. IMPOUNDMENT DESCRIPTION (Continued)
h."Average effluent for L" impoundment (gallons per day and year of record). i, Average daily influent for pil impoundments at this facility (gallons per day and year
I.
FACILITY IDENTIFICATION
etc, (gallons per day and year of record).
*U. S. GOVERNMENT PRINTING OFFICE:
1978--724-845 OM$ NO. 158-S78004
DATE PREPARED
a'.
U.S. ENVIRONMENTAL PROTECTION AGENCY
SURFACE IMPOUNDMENT ASSESSMENT (SIA)
OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL
SECTION 11
SERIAL NUMBER
038409
MONTH DAY YEAR
IMPOUND
�I
r r
STATE CNTY./CITY
PLACE
airy' CATEGORY '' :
SIA SITE NUMBER
f
`_
INSTRUCTIONS; This form is to be completed for one impoundment per site (facility) identified in Section I, Location and Count of Impoundments Form or for one
impoundment per site selected via random sampling procedures. Complete multiple choice questions by entering the code number preceding the appropriate answer,
°,,.. 75 76 177 78 79 80 $aM_
YEAR OF
MENT NO.
YEAR OF
.n
. -
III. IMPOUNDMENT DESCRIPTION (Continued)
h."Average effluent for L" impoundment (gallons per day and year of record). i, Average daily influent for pil impoundments at this facility (gallons per day and year
I.
FACILITY IDENTIFICATION
etc, (gallons per day and year of record).
II. PURPOSE OF IMPOUNDMENT (Enter no. to block 23
a'.
IMPOUND
r r
STATE CNTY./CITY
PLACE
airy' CATEGORY '' :
SIA SITE NUMBER
1. Waste Storage
2. Waste Disposal 3. Waste Treatment (Specify below) 4. Other (Specify below)
YEAR OF
MENT NO.
YEAR OF
.n
. -
a'
Jill
,
GALS:/DAY
GALS./DAY
GALS./DAY
IR�QQFJ
GALS./DAY
a;;
a.a
tU
35 36
37 a
n.,;;
s,;r.
PECIFY"
<- 44 - 49
50 - 56 ,:
22__L r:`.s?a"
23 - 31 o ¢s°: ¢a2 32 35
RECORD
2
$¢° 3
11 13#;,`:
1a aa?r.f
1
aYa�mt•,a"v�;wc,;
orf','
x<t&c.%
RECORD
- 5:ry
6
10t.z
-
14 -
-
9 21
22 a a
23
24 -'�a'
34
:o.w,x»:..a.:<aa:.
RECORD
- -
.•: x . ' "::.:o-. �
attote+`<s+*. X.n .., eta, 'r x:ta+
- o. x:toa-,_.z ^s.>:;>:..,
fi
36 - 0.4
a
x 45 - 48 a'; # a a ¢$ 49
- 57
III. IMPOUNDMENT DESCRIPTION
S8 - 61$:_im
m °
a. 'Age of impou rd
b. IS IMPOUNDMENT
c. If answer to IILb
is
d- If answer to III.b is e. Surface area o[impoundm impoundment.
rr
f, Surface area ofd impoundments
cefi'
' ment in years.
PRESENTLY USED?
.
'yes , give no. o[
'no', give last year
III. IMPOUNDMENT DESCRIPTION (Continued)
k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) 1. FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
IF CLAY LINER NO. 2,3 OR 4 IS SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.)
at this site (in acres). g. Average influent into I" impoundment (gallons per day and year of record).
02. Clay 05. Concrete 08. Polyethylene 11. Hypolon Sheeting 14. Other Membrane type (Specify in bike. 28 - 39.)
1. Cattle 2. Hogs 3. Sheep 4. Poultry 5, Other
I V.. �. Nn
.rPa ; r;
F nnn wr; rt_
r:.. -.7
ti'� ' :a�
III. IMPOUNDMENT DESCRIPTION (Continued)
h."Average effluent for L" impoundment (gallons per day and year of record). i, Average daily influent for pil impoundments at this facility (gallons per day and year
j. Average daily effluent removed from &4impoundments and discharged to streams, lakes,
of record).
etc, (gallons per day and year of record).
YEAR OF
r r
'
5LI
YEAR OF
YEAR OF
.n
. -
a'
Jill
,
GALS:/DAY
GALS./DAY
GALS./DAY
IR�QQFJ
GALS./DAY
a;;
a.a
tU
35 36
37 a
n.,;;
38 39
40 - 43
<- 44 - 49
50 - 56 ,:
22__L r:`.s?a"
23 - 31 o ¢s°: ¢a2 32 35
III. IMPOUNDMENT DESCRIPTION (Continued)
h."Average effluent for L" impoundment (gallons per day and year of record). i, Average daily influent for pil impoundments at this facility (gallons per day and year
j. Average daily effluent removed from &4impoundments and discharged to streams, lakes,
of record).
etc, (gallons per day and year of record).
YEAR OF
YEAR OF
YEAR OF
GALS:/DAY
GALS./DAY
GALS./DAY
RECORD
RECORD
RECORD
fi
36 - 0.4
a
x 45 - 48 a'; # a a ¢$ 49
- 57
S8 - 61$:_im
m °
62 - 70-
;�3��a:
71 74
rr
o.f
cefi'
III. IMPOUNDMENT DESCRIPTION (Continued)
k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) 1. FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
IF CLAY LINER NO. 2,3 OR 4 IS SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.)
01. None 04. Chemically Modified Clay 07. Metal 10. Butyl Rubber Sheeting I3. Chlorinated Polyethylene (in blocks 40 thru 45) AND TYPE (in block46) OF LIVESTOCK.
02. Clay 05. Concrete 08. Polyethylene 11. Hypolon Sheeting 14. Other Membrane type (Specify in bike. 28 - 39.)
1. Cattle 2. Hogs 3. Sheep 4. Poultry 5, Other
03. Bentonite Modified 06. Asphalt 09. Plasticized PVC 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39.)
' ..t•,o*a`6 . '; s c � - 9 a »-,in --- �'-- .<o�.-
�` 'v;i�':`<
�::n'
ti'� ' :a�
�:�-:- co*Ys,o*e;.ca,t6�fl*,�„°''x' g,'�;ot: ayo� --zi � 6----;,crtma'"- -
biis'f�$.''&. �r{°�'ta�bco�ia*<: `ds��,�"kT.f�'�^a A4cF:�\z"�,tc➢2 cx;$�
: �'a--.-::pa �ra,;x> �
-.� / ca�.:�',,,�r�Str,u�A� �:�a i'i>f'�,0'.':
�: ,. ,., :: s'--. .-..-- :. -:- :; a:
-..,tt
«o->`.-��-
,nt#; oihi. s, o}x+-�''�xi ,�_
s 22,..... 25 ,28
45Mail'#m a$sa'$-.
a,.,-',n.sn tx a: •, 'x -
> .-.:,., h ,: :. : ...x. ..2 ¢:2 ¢7 «.:
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGRADATION
. Number of muni- b. FREQUENCY OF GROUND -WATER QUALITY SAMPLING FROM
a. HAVE SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN b. HAS THE GROUND -WATER QUALITY OF DRINKING WATER WELLS IN THE
oring wells asso- MONITORING WELLS.
OBSERVED IN ANALYSIS FROM MONITORING WELLS? (If 'yes', explain AREA BEEN ADVERSELY AFFECTED BY SEEPAGE FROM THIS
iated with this
and describe below how the site was corrected.) IMPOUNDMENT? (If 'yea', explain below.).
impoundment (if 10' '
enter and go to 1. None 4. Monthly 7. Yearly
I. Yes 2. No 3. Unknown 4. Not Applicable 1. Yes 2. No 3. Unknown 4. Nat Applicable (Can only be used when there
question V.b.).
- - - - - - - - - -- - --- -- -- - - - - - - - - - - - are no wells within one mile of impoundment.)
2. Daily 3. Quarterly 8. Other (Specify in blocks 50 thru 61.)
_ _ - ... _
EXPLAIN: EXP LAR+Sr -- - - '-- - - - - - ^ '- '-
3. Weekly 6. Semi -Annually
: t
I �,M
62 63
47 48 t¢ 49 50 - fii t¢
_....-
-
VI. RATING OF THE GROUND -WATER CONTAMINATION POTENTIAL (See instruction manual EPA 570/9-78-003)
VII. WASTE IDENTIFICATION N
STEP I STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 MISCELLANEOUS
Enter the waste identification number
for Part VI, Step 4.
n:h;' }e..
UNSAT. ZONE CONFIDENCE G.W. AVAIL. CONFIDENCE G.W. QUAL. CONFIDENCE WASTE CON;=IDENCE G.W. CONTAM. EALTH HAZARD CONFIDENCE IDENTIFIERS
P O T E N T I A
va
'.j'j✓}�jy�
- k •` J
:a :.:.9 ..:-,,. { � N:,u%kR.o.',:»Ca-.'
V __.d:..:. 3<_'r:a:i::.,::{.;tr. ;_{-{--:-.N,: _.'�i:.,::. ��(f�/y .- Qr+#�u.�' ,t.-: ..::. �::
� a:'F:t.:+P,.$:
.:�.o.- ::6.io.t�-:.. X,'�; .
?'bfYx&..-:._n-.f'n@`„>»� <. 'k.�G',:k#'a:
P3Fb
22 24
"a.�A.:�,
,'{.,if ::N.-W_,
. 25
:''::,�:,,>Q
n--:�%C-::a-_..'-. x-.-:0-`.:
:. 3.e5
31 32 33 34 :.?r�:-.
37 38 40
41 4423
EPA Form 7500-44A (6-78)
STATECOPY

-L). S. GOVE1tf:r,91?ht"T PkIN'TING OFFICC.: 1973-•724.845 04111 NO. 153-S'76'UUd
U.S. ENVINONNIENTAI, PROTE.0 TION ACLI•:NC_Y SERIAL, NUh11IKU
DATE PREPAKUD SURFACE IMPOUNDMENT ASSESSMENT (SIA) Wµ'7 n� �� �+, /` •-:;
MONTH DAY YEAR OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND --WATER CONTAMINATION POTENTIA E.
SF.C7'10N 11'-
> <; INSTRUCTIONS: This form in to be compluted for pnv inlpuundlrtent per situ (L'rrility) identified ill ScCtiurl 1, 1,OCAIiQl1 tint! Count of Inipogndnlcnt;: horn or for one
75 76 77 Ili 79 80 inipounlment per site Selected vin tandonl sanpling prvevdures. Compiote multiltb: choice questions by entering 1:LC code number preceding the• approprintc answor.
1. FACILITY IDENTIFICATION II. PURPOSE OF IMPOUNDMENT (Enter no. in block 23
IMPOUND
STATE CNTY./CITY PLACE CATEGORY r" SIA 5!TE NUMBER 1. Wostc Storage 2. R'as to Disposal 3. SVnste 'I'mntrsrcnt (Sp Deify bola w) q, Other (Specify below) 'pr
MENT NO
A f 3 <• h d��` q7 SPECIFYTT
p T. k
'
Fa Fvfm 7500-44A (5-7I1) � Q. C
�s
i. Averr,pe daily influent for atl Impoundments at this futility (r;nf'ans per day and year
of record),
2
;;
3 -
5
>:'f''
6
10
a
11 - 13 es>
14
- 16
19 - 21
s',_.
Z2
x
a ; f.,wkr
23:z:.;.`
24
_
34 ';a„ ,•`n
^
GALS./DAY
YEAR OF
11. Hypolon SycvtinC
14. Other MOmbrnne type (Specify In blks. 28 - 31.)
8. Otltrr (Specify In blocks 50 ihru 61.)
;:X1 LAIN:
GALS./DAY
"
YcAR OF
'•r'� /r.
35 36 :.� ..
.... ...:. :. 37
5. 011ier ;.ylt
38 39 ,z
III, IMPOUNDMENT DESCRIPTION
44 - 49
50 - 56
'L'.
.. Age of imPounl
-
Z3 31 32 35
b. IS IMPOUNDMENT
c. If answer to IIIb is
d. if answer to 111.1) is
e. Surface
area of impoundment.
f. Surface area ofd impoundments
�48
E
RECORD--
nnent in years.
PRESENTLY
USED.
'yes', give 130. of
'no', give East year
f - v 62 - 70
F
at this site (in ucros),
g. Average influent Into gLLL Impoundment (gallons
per day and year of record).
63
47
1. Yes
2. NO
years In
operation,
of operation.
(in acres)
22 23 24
25 27
!
26
t -- y
3?. 3
Sae �, :x
3i
40
- 45 S.>:
STEP 1
-
STEP 2
STEP 3
-
a s,,[Ya.
a�.7 . zu o -„f # vp.:w;_
MISCELLANEOUS
Enter the waste ldentiflcation number
UNSAT. ZONE ='CONFIDENCE
G.W.
AVAIL.
CONFIDENCE
G.W. QUAL.
ONFiDENCE
WASTE
CONFIDENCE
G.W. CONTAM.
HAZARD
CONFIDENCE
' f;=
r
IDENTIFIER.
for Part VI, Step q,
POTENTIALHEALTH
/�
777
'd
III. IMPOUNDMENT
DESCRIPTION (Continued)
'
Fa Fvfm 7500-44A (5-7I1) � Q. C
�s
i. Averr,pe daily influent for atl Impoundments at this futility (r;nf'ans per day and year
of record),
j. Average daily effIllunt removed from a_'iimpour.dments and discharged to streamc, Lakys0
etc, (gallons per drJy and year of reco_fJ),
_
_
a. 11AVE SIGNIFICANT CIiANOrs IN GROUND --WATER QUALITY BEEN
b. HAS THE G.tCUNP,--WATER QUALITY OF DRINKING WATER WELL$ IN Tlll!,; i
,
_
TYPE OF IIOTTO%E LINER (Enter no, from the types lrslcd Into blacks 23 and 24.)
a
L FOR AGRICULTURAI, IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
IF CLAY LINER. NO. 2,3 OR 4 IS SELECTF,D, GIVE THICKN'EgS IN INCHES (Enter
In blocks 25 rh„t _"7.)
Y£ %R OF
(In bloclr4L) OF LIVF.S'I OC[i.
u 1, None 0.1, Chemically Modified Clay
07. Metal
10. Butyl kul,ber iheeling
13. Chlorinated Potyethyleno
^
GALS./DAY
YEAR OF
11. Hypolon SycvtinC
14. Other MOmbrnne type (Specify In blks. 28 - 31.)
8. Otltrr (Specify In blocks 50 ihru 61.)
;:X1 LAIN:
GALS./DAY
"
YcAR OF
'•r'� /r.
35 36 :.� ..
.... ...:. :. 37
5. 011ier ;.ylt
38 39 ,z
' 40 - 43
44 - 49
50 - 56
'L'.
�
..2
-
Z3 31 32 35
Average effluent for rhi s impoundment (gallons per day and year of record),
i. Averr,pe daily influent for atl Impoundments at this futility (r;nf'ans per day and year
of record),
j. Average daily effIllunt removed from a_'iimpour.dments and discharged to streamc, Lakys0
etc, (gallons per drJy and year of reco_fJ),
_
_
a. 11AVE SIGNIFICANT CIiANOrs IN GROUND --WATER QUALITY BEEN
b. HAS THE G.tCUNP,--WATER QUALITY OF DRINKING WATER WELL$ IN Tlll!,; i
;rtng wells assn-
_
TYPE OF IIOTTO%E LINER (Enter no, from the types lrslcd Into blacks 23 and 24.)
YEAR OF
L FOR AGRICULTURAI, IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
IF CLAY LINER. NO. 2,3 OR 4 IS SELECTF,D, GIVE THICKN'EgS IN INCHES (Enter
In blocks 25 rh„t _"7.)
Y£ %R OF
(In bloclr4L) OF LIVF.S'I OC[i.
u 1, None 0.1, Chemically Modified Clay
07. Metal
10. Butyl kul,ber iheeling
13. Chlorinated Potyethyleno
:. Clay 05. Concrete
YEAR OF
11. Hypolon SycvtinC
14. Other MOmbrnne type (Specify In blks. 28 - 31.)
8. Otltrr (Specify In blocks 50 ihru 61.)
;:X1 LAIN:
GALS./DAY
"
3, Weekly G. Seml-Annually
1. Cattle 2, 1!vus
6
RECORD
5. 011ier ;.ylt
UI. Bentonite hfodified 06. Asphalt
GALS./DAY
12, Ethylene Pto;'tylOne
RECORD
GALS./DAY
�48
E
RECORD--
'
•'
3fi - 44
a5 - a6
_
%'' 49 - 57,`, 58 - 61
f - v 62 - 70
F
7i r :.. .'74
IV. GROUND --WATER MONITORING
V. tiROUND-WATEIZ DEGRADATION
III.
IMPOUNDMENT DESCRIPTION (Continued)
_
a. 11AVE SIGNIFICANT CIiANOrs IN GROUND --WATER QUALITY BEEN
b. HAS THE G.tCUNP,--WATER QUALITY OF DRINKING WATER WELL$ IN Tlll!,; i
;rtng wells assn-
_
TYPE OF IIOTTO%E LINER (Enter no, from the types lrslcd Into blacks 23 and 24.)
()llSI'RVED IN ANALYSIS FROM MONITORING; WELLS? (11 'yes', explain
L FOR AGRICULTURAI, IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
IF CLAY LINER. NO. 2,3 OR 4 IS SELECTF,D, GIVE THICKN'EgS IN INCHES (Enter
In blocks 25 rh„t _"7.)
(in blocks f0 t7rru d5) ANt) 'TYPE
(In bloclr4L) OF LIVF.S'I OC[i.
u 1, None 0.1, Chemically Modified Clay
07. Metal
10. Butyl kul,ber iheeling
13. Chlorinated Potyethyleno
:. Clay 05. Concrete
OS. Polyethylene,
11. Hypolon SycvtinC
14. Other MOmbrnne type (Specify In blks. 28 - 31.)
8. Otltrr (Specify In blocks 50 ihru 61.)
;:X1 LAIN:
'"'":'•
"
3, Weekly G. Seml-Annually
1. Cattle 2, 1!vus
6
3, Sheep 4. Poultry
p y
5. 011ier ;.ylt
UI. Bentonite hfodified 06. Asphalt
09. Plasticized PVC
12, Ethylene Pto;'tylOne
15, 011ter (Specify in blocks 28 lhru 39.)
."'� '! •'- _
�48
E
ice£ R°.f',
62
63
47
49 50 - Si
22 23 24
25 27
!
26
t -- y
3?. 3
Sae �, :x
3i
40
- 45 S.>:
STEP 1
-
STEP 2
STEP 3
-
a s,,[Ya.
a�.7 . zu o -„f # vp.:w;_
MISCELLANEOUS
Enter the waste ldentiflcation number
IV. GROUND --WATER MONITORING
V. tiROUND-WATEIZ DEGRADATION
Nanber of mani-
b. FREQUENCY OF CIZOUND--WATER QUALITY SAMPLING FROM
_
a. 11AVE SIGNIFICANT CIiANOrs IN GROUND --WATER QUALITY BEEN
b. HAS THE G.tCUNP,--WATER QUALITY OF DRINKING WATER WELL$ IN Tlll!,; i
;rtng wells assn-
MONITORING WELLS,
()llSI'RVED IN ANALYSIS FROM MONITORING; WELLS? (11 'yes', explain
ARL"A L3EFN AUVL'RSI 1 Y r1FFL'CT1 D DY S -EPAGE FROM TII1S .+; - ,'', 1=1'!I,
',";.-�
i::;ciL with tills
.,nd doseribo below how the sire Was corrected.)
'IMPOUNDMENT? (If 'yos', explaln below-). •-'
i,puundinent (11 10'
nr.r and Co to
1, None 4. Monthly
7. Yearly
1. Yes 2. No 3, Unknown 4, Not Appficut,te
•,... er �:,
1. Yes 2. No J. Unknown 4. Not App rlcable (Can only bo Used When {here';!!
-- - - - - - - - - - --- '- -' - - -- - - --
no +volts within ono ncrie o1 lmpoundnront.)�
2. Rally 5. Quarterly
8. Otltrr (Specify In blocks 50 ihru 61.)
;:X1 LAIN:
- _ - -, - -_- - - - _aro
LXPLAIN'. -
"
3, Weekly G. Seml-Annually
- - - -i-j';'A�1:�1,•
W:
�48
E
62
63
47
49 50 - Si
!
VI. RATING OF illi: GROUND -WATT- R CONTAMINATION POTENTIAL (Seo instruction marizrfrl EPA 570/9-78-003)
VII WA 1T, DE?t " I CAQN NO,
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP b
MISCELLANEOUS
Enter the waste ldentiflcation number
UNSAT. ZONE ='CONFIDENCE
G.W.
AVAIL.
CONFIDENCE
G.W. QUAL.
ONFiDENCE
WASTE
CONFIDENCE
G.W. CONTAM.
HAZARD
CONFIDENCE
' f;=
r
IDENTIFIER.
for Part VI, Step q,
POTENTIALHEALTH
/�
777
'd
22
: , '.. 2 2 „-: _ -...., ::
2
2
:'. x
-: ,; ;: Z fy
3
�- . _
t
_
Y' 32
a. '< 34 q: 7
:Y',,.
:.f:.$i 35 3
1 a.
b'
37
f. "*.:'..'4wr..�...
},fix 38 40
n..1 S. m'.C�.
k>..: a d 1 44
•i6:k.
: +i•; «,;.t