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Home My WebLink AboutMITCHELL BROOME HOG PARLOR_MISC_2017123114 SO Control Hu ber County Number 3 GROUNDWATER POLLUTION SOURCE INVENTORY o4? Source Na OWNERSHIP /JYDO/Yi � d V_ �rivate 2 Municipal Source dress .01 _ C baa o., N. side, of SR R 16 S ,0.5,.i_ 3 County 4 State Ci ty County Region D� H�07t 5 Federal 6 Military Owner/Operator 1 Quad NameI'MultipleSourcegi e oun y ource s YES POTENTIAL SOURCE OF GROUNDWATER POLLUTION ,L KATION OPERATION TYPE TYPE OF WASTE DISPOSAL FACILITY OTHER SOURCE J1, Facility 1 Municipal l Gasoline/diesel 0 Lagoon, etc. 1 Agricultural Activity 2 Highway 2 Industrial 2 Other oil 2 Landfill -centro. 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 0 Sewage/septage 6 Sewer system 6 Intentional dump 7 Other 'J 7 Sludge 7 Septic tank 7 Spill 8 Leachate 8 Injection well 8 Leak --above ground 9 Other solids 9 Disposal well 9 Leak --underground 1D In use 10 Gas WASTE: STATUS OF SOURCE: 2 Inactive 11 Pest/herbicides 3 Other 12 Fertilizers POLLUTION STATUS AND CROSS-REFERENCES GROUNDWATER POLLUTION FACILITY PERMITTED: Yes No 1 Confirmed (3) Rank 1 NPDES 6 Mining 2Q Potential 2 Tabulate No: 2 DEM Nondischarge No: 7 Hazardous Waste (RCRA) MONITORING WELLS No: No: I No monitoring 2 State has data 3 Well Construction 8 Solid Waste (Landfill) 3 Data at facility No: No: O4 Status unknown 4 Capacity Use 9 Oil Terminal Registration DATABASE CROSS-REFERENCE No: No: 1 ERRIS (CERCLA) list 5 UIC 0 Air Quality ID: No: No: 2 Surface Impoundment (SIA) Comments ID; 3 GW Pollution Source Inv. Date: 4 Other DEM investigation Date: Compiler: Date: FORK AROVED 03�� f OMB NO,P1P58—S78004 DATE PREPARED U.S. ENVIRONMENTAL PROTECTION AGENCY SURFACE IMPOUNDMENT ASSESSMENT (SIA) LOCATION AND COUNT OF IMPOUNDMENTS SERIAL NUMBER A-LfL MONTH - DAY R t", SECTION I 75 76 77 78 79 80 FACILITY IDENTIFICATION How many impoundments are: STATE IDENTIFICATION NO. (Optional) FTS�T�ATE CNT-Y./CITY PLACE CATEGORY SIA SITE NUMBER located at this site? 21 TFM A 6131715 -�11 \dl 1 2 3 5 6 10 11 13 14 22 23 251 26 37 STANDARD INDUSTRIAL SITE LOCATION NPDES NUMBER CLASSIFICATION (SIC Code) —01, DEC DEGREES MINUTES SECONDS MfNq)TES DEGREES SFco D5 I OP AID LATITUDE 10 4-1 q 1-5 j LONGrrUDE---fo- 31 P38 46 ? 47 - so 54 155 56 ?.Q: 57 59 60 61 162 63 OWMER NAME OF OWNER I Nide B1 KI I 61 1 N I 16) 1 If 1A 19,1 Ll 0 19 1 1 1 1 1 1 1 1 1 1 -DA -M-1 22 5.9 OWNER'S MAILING ADDRESS (Street No. or P.O. Box) CITY OR TOWN STATE ZIP CODE C) 52 53 54 55 59 OPERATOR NAME OF OPERATOR I-rl C-1 H I LL 1 o I d .8K 22 59 OPERATOR'S MAILING ADDRESS (Stre,Y No. or P.O. Box) 67, -J 7 22 9 CITY OF, TOWN STATE ZIP CODE .X. �X 12252 .53 54 55 - 59 EPA Form 7500-44 (6-78) STATE COPY GROUND WATER DIVISION CE OF WATER AND AIR RESOURCES OF NATURAL AND ECONOMIC RESOURCES OF GROUND W411 T FR POL.LUTION SOURCE RECORD ?Y:_ 1r/ ilinr _ C'> -ter,• �� DATE -7 L7%79 W.D. PERMIT NO. 'OW,',4: COUNTY: LOCA+ i I 0IN (SKETCH ON BACK): 'ti' e- 15722 *A-1 /✓- s r'dc oy�' t. z1 `S" 01,1,NER (S) OF FACILITY OR INSTALLATION: 8Pg lL f;i.i F I L L, L FiaGON, kip% cJ•��0 ,'>01 AND QUANTITY OF POLLUTANTS: l,,R r��s 4rtp. _r�;_ car• • �;r- DESCRIPTION OF FACILITY (SKETCH ON BAC -0: HYDRC!C=OLOGIC CONDITIONS AT SITE: POLLUTION CONFIRMED BY ANALYSIS? DATE ANALYST: MONITO-RING FACILITIES INS-TALLED: SC;-'.=DUL E: N`:;R_ST STREAM: Lt -T' DISTANCE Gna' lir NEriRES i otATER SUPPLY WELL: DISTANCE ANALYSES AND OTHER DATA AVAILABLE: o ✓� r FOR,' -'.r �G'.r-- s J r GR0UN.DWATE° P0LLUTI0N 5 0 U R C E RANKING C R I T E P I A THREAT TO GROUNDWATER Probability of Groundwater Violations 3 Violations documented or highly probable Default 1 Violations unlikely . Ex ent of Groundwater Contamination 3 Mappable, migrating plume 2 Default 1 Insignificant contamination expected Seriousness of Groundwater Threat 20Oneof most serious in DEM region Default I Not considered a serious problem FEASIBILITY FOR TAKING ACTION Feasibility for Remedial Action 03 Remedial action both feasible and desirable 2 Default 1 No remedial action recommended Desirability of Remedial Action One of top regional office priorities Default 1 Not a priority incident s2 THREAT TO PEOPLE OR ECONOMY E V A L U A T I O N How Hazardous to Health/Economy 3 People or business advised of contamination 0 Default 1 No expected impacts on people or business Number of People at Risk 3 4 or more family units, or $10,000 loss 0 Default �/I No people or other interests at risk Seriousness of People Threat 26 Strong DEM concern over threat to people Default 1 No threat'to people or economy _ J FEASIBILITY OF RECLASSIFYING GROUNDWATER Need to Reclassify Croundwater 3 Groundwater should be relassified RS or GC 0 Default I No reclass. nor remedial action recommended Desirability of Reclassification 3 One of top reclassification priorities 2 Default 1 Not a priority incident THREAT OF POLLUTANTS How Toxic are Pollutants (use Sax) 3 High value 0Mad value I Low or None value Quantity of Pollutants in Ground 3 Reportable quantity of hazardous material (CERCLA def.) or quantity of real concern Default 1 Not of concern to regional office Seriousness of Pollutant Threat 3 One of most serious in DEM region Default 1 Not a serious threat RANK SCORE: Source Name: Control Number: go y V County: oly Ranker: Date: HATE PREPARED MONTH DAY YEAR 75 76 77 78 74 80 STATE CNTY./CITY 1 2 FMN 3 - 5 rvrcin rirrr' r_U *U. S. GOVERNMENT PRINTING OFFICE: 1978-724-845 ON8 NO. 158-S78f III. IMPOUNDMENT DESCRIPTION (Continued) U.S. ENVIRONMENTAL PROTECTION AGENCY k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) SERIAL NUMBER INATION POTENTIAL (See instruction manual EPA 570/9-78-003) IF CLAY LINER NO. 2,3 OR 4 I SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) SURFACE IMPOUNDMENT ASSESSMENT (SIA) 01. None 04. Chemically Modified Clay 07. Metal i. Average daily influent forpli impoundments at this facility (gallons per day and year j. Average daily effluent removed from OPERATIONAL FEATURES OF THE IMPOUNDMENTGROUND-WATER CONTAMINATION POTENTIAL of record). -1 SECTION 1 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39,) 038406 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. 36 - 40 >'am,'m .;: .z.�,¢s: c¢.a`` 41 _ / YEAR OF 1. FACILITY IDENTIFICATION II, PURPOSE OF IMPOUNDMENT (Enter no. in block 23 IMPOUND- PL ACE' TTTYEAR CATEGORY,; SIA SITE NUMBER Waste Storage 2. Waste Disposal 3. Waste Treatment ( P YSpecify below) 4. Other S ecif below) ( n > Ax �:� ':. MENT NO '+9 GALS./DAY a* w '� dab: A '+� zo-....... �,a„KaS' s,`;;..-: V ! YEAR OF � .;v^--- ., yam, xa;»;o,.9 #G�am;;sx?�:6+, �:;.� ..��fl*' :.� .. v, .�M".:.dM:' --:.a- ✓ � V. GROUND -WATER DEGRADATION GAL 5./ D A Y a. HAVE SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN b. HAS THE GROUND -WATER QUALITY OF DRINKING WATER WELLS IN-THfi oring wells assn- MONITORING WELLS. OBSERVED IN ANALYSIS FROM MONITORING WELLS? (if `yes', explain �„J RECORD iat� with thi a and describe below how the site was corrected.) GALS./DAY 'mpaundment (if 10' SPECIFY nter and go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4. Not Applicable RECORD uestlon V.b.). - - - - - - - - - - -- -- - - - - - - - - �-- -� - - - - _ - - � - � - - _are no wells within one mile of impoundme - 2. Daily $. Quarterly S. Other (Specify in blocks 50 thru '�',r,; 9s6 23 '�&`�c #:ga6 EXPLAIN: - - - 3. Weekly 6. Semi -Annually 10 11 - 13 .,'; 14 - 18 <ai 19 - 21 °'t 22wra6+ xaw"�y „ 24 _ ,38 39, 437 9xo50 Ill. IMPOUNDMENT DESCRIPTION 2 a,�A a of impound b. IS IMPOUNDMENT 1c. If answer to IILb isd. If answer to III.b is e. Surface area of i Pg peurdmpoundment. f, Surface area of impoundments PRESENTLY USED? 'yes', ive no. of 'no', give last ear at this site (in acios , g. Average influent into impoundment cellons Ment in years. g Y (' ) g x�iiS � p ($ Per day and year of record). 1. Yes 9. Nrl vears in oneration_ I of oneratiol I /in acres) 47 48 49 : 50 VI. RA AN .: STEP 1 STEP UNSAT. ZONE CONFIDENCE G.W. AVAIL. 1 !gib :x ,<.. 23 24 ..;a ;' ' ^�: 25 � 26 27 EPA Form 7500-44A (6-78) 61 62 LING OF THE GROUND -WATER CON' STEP 3 ONFIDENCE G.W. QUAL. CONFIDENCE a � dsD ..: . x�•� 28 ».�� ?�::�ri. 129 M _- : 30 III. IMPOUNDMENT DESCRIPTION (Continued) k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) III. IMPOUNDMENT DESCRIPTION (Continued) INATION POTENTIAL (See instruction manual EPA 570/9-78-003) IF CLAY LINER NO. 2,3 OR 4 I SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) h. Average effluent for JhLL impoundment (gallons per day and year of record), 01. None 04. Chemically Modified Clay 07. Metal i. Average daily influent forpli impoundments at this facility (gallons per day and year j. Average daily effluent removed from impoundments and discharged to streams, lakes, 11. Hypalon Sheeting 14. Other Membrane type (Specify in blks. 28 - 39.) of record). -1 etc, (gallons per day and year of reco). 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39,) �k .I 31 m`r °aY 32 ?9?.'..�`x 33 34 rls:; .:.�«:,,, 35 36 -i .,,u,?R.k„ 37 36 - 40 >'am,'m .;: .z.�,¢s: c¢.a`` 41 _ / YEAR OF YEAR OF '{��p9 E. � ° TTTYEAR ^�'� *fix t._ s, <: , h.. -- n > Ax �:� ':. " `°'t; r '+9 GALS./DAY a* w '� dab: A '+� zo-....... �,a„KaS' s,`;;..-: V ! YEAR OF � .;v^--- ., yam, xa;»;o,.9 #G�am;;sx?�:6+, �:;.� ..��fl*' :.� .. v, .�M".:.dM:' --:.a- ✓ � V. GROUND -WATER DEGRADATION GAL 5./ D A Y a. HAVE SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN b. HAS THE GROUND -WATER QUALITY OF DRINKING WATER WELLS IN-THfi oring wells assn- MONITORING WELLS. OBSERVED IN ANALYSIS FROM MONITORING WELLS? (if `yes', explain �„J RECORD iat� with thi a and describe below how the site was corrected.) GALS./DAY 'mpaundment (if 10' nter and go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4. Not Applicable RECORD uestlon V.b.). - - - - - - - - - - -- -- - - - - - - - - �-- -� - - - - _ - - � - � - - _are no wells within one mile of impoundme - 2. Daily $. Quarterly S. Other (Specify in blocks 50 thru ' EXPLAIN: EXPLAIN: - - - 3. Weekly 6. Semi -Annually RECORD ,38 39, 437 9xo50 56 2 48 23 31 49 32 35 47 48 49 : 50 VI. RA AN .: STEP 1 STEP UNSAT. ZONE CONFIDENCE G.W. AVAIL. 1 !gib :x ,<.. 23 24 ..;a ;' ' ^�: 25 � 26 27 EPA Form 7500-44A (6-78) 61 62 LING OF THE GROUND -WATER CON' STEP 3 ONFIDENCE G.W. QUAL. CONFIDENCE a � dsD ..: . x�•� 28 ».�� ?�::�ri. 129 M _- : 30 III. IMPOUNDMENT DESCRIPTION (Continued) k. TYPE OF BOTTOM LINER (Enter no. from the types listed into blocks 23 and 24.) III. IMPOUNDMENT DESCRIPTION (Continued) INATION POTENTIAL (See instruction manual EPA 570/9-78-003) IF CLAY LINER NO. 2,3 OR 4 I SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) h. Average effluent for JhLL impoundment (gallons per day and year of record), 01. None 04. Chemically Modified Clay 07. Metal i. Average daily influent forpli impoundments at this facility (gallons per day and year j. Average daily effluent removed from impoundments and discharged to streams, lakes, 11. Hypalon Sheeting 14. Other Membrane type (Specify in blks. 28 - 39.) of record). -1 etc, (gallons per day and year of reco). 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39,) 31 m`r °aY 32 ?9?.'..�`x 33 34 rls:; .:.�«:,,, 35 36 -i .,,u,?R.k„ 37 36 - 40 >'am,'m .;: .z.�,¢s: c¢.a`` 41 _ / YEAR OF '{��p9 TTTYEAR OF GALS./DAY dab: A '+� zo-....... �,a„KaS' s,`;;..-: :$'„9, `�, '�.$`.O'��'ik;�,��„� °��.-' -: ANrtox*,d °d ': .--- 3�. .. --- YEAR OF - 39a''0e°`, y€`o-m`b °' a v $d'k`4o-kg d?. 40 - 45 46.a, '" `b3. .;v^--- ., yam, xa;»;o,.9 #G�am;;sx?�:6+, �:;.� ..��fl*' :.� .. v, .�M".:.dM:' --:.a- GALS:/DAY V. GROUND -WATER DEGRADATION . Number ofmoni- 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-THfi oring wells assn- MONITORING WELLS. OBSERVED IN ANALYSIS FROM MONITORING WELLS? (if `yes', explain �„J RECORD iat� with thi a and describe below how the site was corrected.) GALS./DAY 'mpaundment (if 10' nter and go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4. Not Applicable RECORD uestlon V.b.). - - - - - - - - - - -- -- - - - - - - - - �-- -� - - - - _ - - � - � - - _are no wells within one mile of impoundme - 2. Daily $. Quarterly S. Other (Specify in blocks 50 thru 61.) EXPLAIN: EXPLAIN: - - - 3. Weekly 6. Semi -Annually RECORD 36 - 44srld':rCd.s'. 45 - 48 ,'.".'>°=«»; 49 - 57 58 - 61 ,e8.1$dal 62 - 70 71 - 74 47 48 49 : 50 VI. RA AN .: STEP 1 STEP UNSAT. ZONE CONFIDENCE G.W. AVAIL. 1 !gib :x ,<.. 23 24 ..;a ;' ' ^�: 25 � 26 27 EPA Form 7500-44A (6-78) 61 62 LING OF THE GROUND -WATER CON' STEP 3 ONFIDENCE G.W. QUAL. CONFIDENCE a � dsD ..: . x�•� 28 ».�� ?�::�ri. 129 M _- : 30 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 INATION POTENTIAL (See instruction manual EPA 570/9-78-003) IF CLAY LINER NO. 2,3 OR 4 I SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.) STEP 4 STEP 5 STEP 6 01. None 04. Chemically Modified Clay 07. Metal (in blocks 40 thru 45) AND TYPE (in block46) OF LIVESTOCK• 10. Butyl Rubber Sheeting 13. Chlorinated Polyethylene WASTE CONFIDENCE G.W. CONTAM. HEALTH HAZARD CONFIDENCE POTENTIA 02. Clay 05• Concrete 08. Polyethylene 11. Hypalon Sheeting 14. Other Membrane type (Specify in blks. 28 - 39.) 1. Cattle 2, Hoga 3. Sheep 4. Poultry $, Other 2'--- 03. Bentonite Modified 0& Asphalt 09. Plasticized PVC 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39,) 31 m`r °aY 32 ?9?.'..�`x 33 34 rls:; .:.�«:,,, 35 36 -i .,,u,?R.k„ 37 36 - 40 >'am,'m .;: .z.�,¢s: c¢.a`` 41 _ '{��p9 dab: A '+� zo-....... �,a„KaS' s,`;;..-: :$'„9, `�, '�.$`.O'��'ik;�,��„� °��.-' -: ANrtox*,d °d ': .--- 3�. .. --- '»`dfivx:di.?o`d3' 22 23 24'; 25 - 27 _., 28 - 39a''0e°`, y€`o-m`b °' a v $d'k`4o-kg d?. 40 - 45 46.a, '" `b3. .;v^--- ., yam, xa;»;o,.9 #G�am;;sx?�:6+, �:;.� ..��fl*' :.� .. v, .�M".:.dM:' --:.a- IV. GROUND -WATER MONITORING V. GROUND -WATER DEGRADATION . Number ofmoni- 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-THfi oring wells assn- MONITORING WELLS. OBSERVED IN ANALYSIS FROM MONITORING WELLS? (if `yes', explain AREA BEEN ADVERSELY AFFECTED BY SEEPAGE FROM THIS iat� with thi a and describe below how the site was corrected.) IMPOUNDMENT? (If 'yes', explain below.). 'mpaundment (if 10' nter and go to 1. None 4. Monthly 7. Yearly 1. Yes 2. No 3. Unknown 4. Not Applicable 1. Yes 2. No 3. Unknown 4. Not Applicable (Can only be used when the uestlon V.b.). - - - - - - - - - - -- -- - - - - - - - - �-- -� - - - - _ - - � - � - - _are no wells within one mile of impoundme - 2. Daily $. Quarterly S. Other (Specify in blocks 50 thru 61.) EXPLAIN: EXPLAIN: - - - 3. Weekly 6. Semi -Annually 47 48 49 : 50 VI. RA AN .: STEP 1 STEP UNSAT. ZONE CONFIDENCE G.W. AVAIL. 1 !gib :x ,<.. 23 24 ..;a ;' ' ^�: 25 � 26 27 EPA Form 7500-44A (6-78) 61 62 LING OF THE GROUND -WATER CON' STEP 3 ONFIDENCE G.W. QUAL. CONFIDENCE a � dsD ..: . x�•� 28 ».�� ?�::�ri. 129 M _- : 30 63 ?-_: ittfi:_., .: .r.:. - ,,,..,, mdAath INATION POTENTIAL (See instruction manual EPA 570/9-78-003) VII. WASTE IDENTI STEP 4 STEP 5 STEP 6 MISCELLANEOUS IDENTIFIERS Enter the waste identifi for Part VI, Step 4. WASTE CONFIDENCE G.W. CONTAM. HEALTH HAZARD CONFIDENCE POTENTIA dP:--- 2'--- I'TWWW." 31 m`r °aY 32 ?9?.'..�`x 33 34 rls:; .:.�«:,,, 35 36 -i .,,u,?R.k„ 37 36 - 40 >'am,'m .;: .z.�,¢s: c¢.a`` 41 _ -U. S. C.CJVL1;t1..1L'r'JT PRINI'lNG (_)FVICIp: 1973-724-845 EPA Form 7500-44A (6-78) •V. w P-4 1E P44copy V,8. ENvINUNNIENTAI, A('.I-"NCY SURIAL NUMUVR DATE SURFACE IMPOUNDMENT ASSESSMENT (SIA) OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL " . ..... :... IIONTkt DAY YEAR � SECTION 11 INSTRUCTIONS: Thi:' forn, is to be completed for oiw impumidmealL per site (facility) identified in Seciiort-I, 11--_11tioij arid Count of Intpoi4ndincilt0 porta or ror one by citterhij,, Ill,! co(je 1jujilber prect-ditlil tht! oppr pr swo.r. impoundrim-rit per !;itc sclvctotl vin random �tlnpilinjl. COMI)I0C llltlltij)k� CILIL-Sti011t] 0 [[Ito t )Ii ChOiCC 75 7r, 77 78 79 BO I . FACILITY IDENTIFICATION II. PURPOSE OF IMPOUNDMENT (11-'nfvr no. in block 23) STATE CNITY JCITY PLACE CATEGORY SIA SITE NUMBER & IMPOUND- 'AR 1. WUSW Storage 2. Waste D15POual 3. Wits to Treatment (Specify bal w 4 Other (Specify bejqwj MFNT NO. X K xA� 5sSPECIFY 2 77 to I 1 13 14 is 19 21 22 23 34 3UR 77777 III. IMPOUNDIAHINT DESCRIPTION Age of Imp I b. Is ImPOUNDMENT ,hent irk ye fr'37 PRESENTLY USE D? C. If answer to Hl.b is 'yes give no. of d. If a n 5xve r to 111.10 is 'no',give last year a Surface aren of impoundment. f. Surtrice ea Ofauimpoundments ar at this site (in ucres). g. Average Influent into jhjj impoundment (gallono per day and year of record), 1. Yes 2. NO years In operation. of operation. (!r? acres) I Lo GAL SWDAY YEAR OF R R rC'ORD oi�, 35 37 36 38 39 21LI 40 43 44 49 4. ., 50 22 23 3, 32 7 DESCRIPTION (Con 7� 1I.- Average effluent for Itla impoundment (gallons par day and year of record), I. Average daily influent forall impoundments at this facility (gallons per day and year Average daily effluent removed from -11 impoundments as%d discharged to rtrqumFi,IUkFr, of record). etc, (gallons per dny and year of roe 17). •YEAR YEAR OF YEAR Or J_ 1 OF =RECORD 7w GALS./DAY RECORD DAY GALS./ RECORDI GALS./DAY .1 - 313 44 48 49 57 53- 61 77777777777777 62 70 q , 7 1 1. 1: �;:.7 7. Ill. IMPOUNDMENT DESCRIPTION (Continued) rr 4 TYPE OF BOTTOM LINER (Ertler no. from the types listed into blocks 23 and 24.) CLAY LINER 2,3 4 IS SELECTED, GIVE THICKNESS IN INCHES (Lrifer in blocks 25 thra 27.) "Jj;-_ , 1. FOR AGRICULTURAL !hIPOUND!AZNT 011,1Z AVERAGE DAILY N'UhIBER I. IF NO. OR (in blocks 40 thru 45) AND TYPE (in black4lCi) OF LIVESTOCK. y 13. Chlorinated Polyethylene U 1, L None 04, Chemically Modified CIn 07. Metal 10. Butyl Rubber Sheeting -A. Z L'. "C la y 05. Concrete 03. Polyethylene 11. Hypa:or, Soveting! 14, Other Ifembrone type (Specify in blkv. 26 39.) S. the, - 1, Cattle 2. Flogs 3. Sheep 4. Po%%Itry 0 03. Bentonite Modified 06. Asphalt 09. Plasticized PVC 12. Ethylciiv Fropylcne I$, Other (Specify in blocks 28 thru 39.) ......................... 0 ....................... .................................... > ;.Y 23 24 27 28 PL ? 4 0 45 46 IV. GROUND --WATER MONITORING V, GROUND -WATER DEGRADATION Number of moral- 1). FrLQ11I11'NCY OF GROUND-WA,rli-:ii QUALITY SAMPLING FROMu. HAVE SIGNIFICANT CliANOES IN' GROUND -WATER QUALITY BEEN b. HAS TIME GNOUND-WATER , QUALITY OF DRINKING WATER WELL$ lil T114 -.ii :v rlu wells avau- MONITORING Wl`�LLS. OuSEKVLJ) IN ANALYS11, FROM MONITORING WE'LL$? (If 'yam', -Xpi"ln arld aV4;r-r(bV below Iluiv 1110 zritv IwAs corrucied.) AREA UE -LN Al)VLISLlY AFFF'CTED BY 5EEPAGL-; FROM TillS 14IPOUNI)1tilLNT? (11 Vos', vxP!L1i1j bufal-). With this ,i.,Vaundtitcnj ,Wwr Mild go 10 1. Nono -1. Muntilly 7. Yoarly 1. Yes 2. No 3. UnIctiowii 4. Not Applicable I. you 2. Nu 3. Ul1I<1iowtL 4. NA Applicable (Can only be W -ad whalihorel.- ; -'- - - - - - '^ - ^ - - ury ito wolls wNhin alto witsp of Impout r(kilailf.) V,b.)v 2. Dally S. Quarturly S. Other (Specify ill blocks 50 111rif 61.) N; ^ - - _ - _ T L%i� LWIW, lf;j 3. Weekly I,. ScmI.-Annuittly -T I I I I 47 40 4? 50 t W16 7'. V1, RATING 0F T[ E, GROUND-WATP',R CONTAMINATICIN T"OTEN-1,11A L. (s20 111 t-11011 "l -l-21- 14'PA 570/9-73-003) Vjj_WASTF 1L)FNjjELCA'I*I0U NO STEP I STEP 2 STEP 3 STEP -1 STEP 5 STEP 6 MISCELLANEOUS Enter the wuste Idunufication numb for ENTlIFIERS Parl. V1. Step 1, UNSA T. ZONE CONFIDENCE G.W. AVAIL. CONFIDENCE G.W. QUAL. CONFIDENCE WASTE CON] G.W. CONTAf4. HEALTT( HAZARD CONFIDENCE r. LA 7`_ 77=1 25 2 G 27 MT 38 41 44 EPA Form 7500-44A (6-78) •V. w P-4 1E P44copy