PE BAZEMORE HOG PARLOR_MISC_20171231

HL APR 13 10
Si ., ,.ti
Control Number
County Number
GROUNDWATER POLLUTION SOURCE INVENTORY
66 b
Source Nameff��
L.
OWNERSHIP
X 1616 e Y�7 62@,
r ArZ
O Private
2 Municipal
Source Address �+!!
Q� SR W. 'S'l 5R
M; N d Jq47_6-
1,75q
3 County
4 State
City
C/oun-ty
Region
P7 UC
i1d-1
5 Federal
6 Military
Owner/ perator
f Quad Name
Multiple Sourcesita
oun y Source Us
YES No
POTENTIAL SOURCE OF GROUNDWATER POLLUTION
OPERATION TYPE
TYPE OF WASTE
DISPOSAL FACILITY
OTHER SOURCE
,LOCATION
Facility
1 Municipal
i Gasoline/diesel
0 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
O6 Sewage/septage
6 Sewer system
6
Intentional dump
7 Other
7 Sludge
7 Septic tank
7
Spill
B Leachate
B Injection well
8
Leak --above ground
9 Other solids
9 Disposal well
9
Leak --underground
lO In use
10 Gas
WASTE: 11
maa S7G
STATUS OF SOURCE: 2 Inactive
11 Pest/herbicides
'an'
3 Other
12 Fertilizers
POLLUTION STATUS AND CROSS-REFERENCES
GROUNDWATER POLLUTION
FACILITY PERMITTED: Yes No
1 Confirmed IO Rank
1 NPOES
6 Mining
O2 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:
4QStatus 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 Impouundment (SIA)
ID: 7-4.._
Comments! _
ean /, h4� w� /rr+fi�rvi ocrs ClA y � X 8o X 3 'tep
3 GW Pollution Source Inv.
Date:
4 Other DEM investigation
Date:
Compiler:
Date:

FORM VED
\j Y
Y~� "`���` "- S3�
� OUR NO. 158-S78004
DATE PREPARED
`1
U.S. ENVIRONMENTAL PROTECTION AGENCY
SERIAL NUMBER
.
MONTH DAY YEAR
SURFACE IMPOUNDMENT ASSESSMENT (SIA)
#.
{�
LOCATION AND COUNT OF IMPOUNDMENTS
SECTION 1
. x 75 76 n 78 79 eof€
FACILITY IDENTIFICATION How many impoundments are
STATE IDENTIFICATION NO. (Optional)
STATE CNTY./CITY PLACE CATEGORY SIA SITE NUMBER - located at this site.
q1311 10
,:N
1 2 3- 5 fi - 40 11 - 13 14 - 18 22 23 - 25 ;, ...
26 - 37
STANDARD INDUSTRIAL SITE LOCATION
NPDES NUMBER
CLASSIFICATION (SIC Code) DEGREES MINUTES SECONDS ''.ry � } DEGREES MI NI)TES SFCONDS
', 3 y
S
L:
011Z1ITUDE—�
LAT
1 LONGITUDE -1-
Y, -511
47 $p r`^re;»*,_,, 55
_ n% 5i 52 53 54 56,;{" 60 61 52 63
OWNER
NAME OF OWNER
z
F
1N()16;
PIq I KI
LOP
-1
$-
s 22 - 59
OWNER'S MAILING ADDRESS (Street No. or P.O. Box)
3
N
ox
N16111
ISIRI1
'
_
"i 22 _ 59 0 ..
CITY OR TOWN
STATE
ZIP CODE
MIDI
hl
DEET
EI
I
I
I
I
I I
I
I
I
1
1.1
1 1
1 1 1
1 1
NIL
11
Derry
2252
.,.. -
53 54
55 59
OPERATOR
NAME OF OPERATOR
22 - 59
OPERATOR'S MAILING ADDRESS (Streelt No. or P.O. Box)
y�
1A
I22
CITY OR TOWN
STATE
ZIP CODE
K. 22 - 52
53 54
55 - 59
FPA r— 7500_44 (6-78) STATE COPY

GROUND WATER DIVISION
OFFICE OF WATER AND AIR RESOURCES
,L -
ut o N
63
DEPARTMENT OF NATURAL AND ECONOMIC RESOURCES
RECORD OF GROUND WATER POLLUTION SOURCE
RECORD BY:_/�.'n�DATE 9,17%79 W.D. PERMIT NO.
TOWN _ .res -r �o C - COUNTY l/1✓��'d/�
LOCATION (SKETCH ON BACK):
OWNERS) OF FACILITY OR INSTALLATION: PC•�zer�d-y_C /i9zr►��c !`�o yl,��
TYPE SOURCE: (LAND FILL, LAGOON, ETC.)
CHARACTER AND QUANTITY OF POLLUTANTS:�i�r��� / %f✓�s��r
DESCRIPTION OF FACILITY (SKETCH ON BACK):
HYDROGEOLOGIC CONDITIONS AT SITE:
POLLUTION CONFIRMED BY ANALYSIS? DATE ANALYST:
MONITORING FACILITIES INSTALLED:
SAMPLING SCHEDULE:
NEAREST STREAM://- g /c �p• ,f_� �Y�M'� _ _ DISTANCE
NEAREST WATER SUPPLY WELL: f foeZX r Y DISTANCE -700
,
ANALYSES AND OTHER DATA AVAILABLE:
REMARKS: r _o- e -
FL
IVC- 2- arr-11b
f
FORM GW -46

s

G R O U N D 1i A T E !? P O L L U T I O N S O U R C E E V A L U A T I O N
R A N K I N G C R I T E R I A
THREAT TO GROUNDWATER
S THREAT TO PEOPLE OR ECONOMY
THREAT OF POLLUTANTS
Probability of Groundwater Violations
How Hazardous to Health/Economy
How Toxic are Pollutants (use Sax)
Violations documented or highly probable
3 People or business advised of contamination
3 High value
/3
`l 21 Default
l
/
(`� Default
/
!2 '1 Mad value
`1J
I Violations unlikely
I No expected impacts on people or business
Low or None value
Extent of Groundwater Contamination
Number of People at Risk
quantity of Pollutants in Ground
Mappable, migrating plume
3 4 or more family units, or $10,000 loss
3 Reportable quantity of hazardous material
(CERCLA def.) or quantity of real concern
2 Default
O Default
C2Oe fau1t
1 Insignificant contamination expected
I No people or other interests at risk
1 Not of concern to regional office
Seriousness of Groundwater Threat
Seriousness of People Threat
Seriousness of Pollutant Threat
3 One of most serious in DEM region
3 Strong DEM concern over threat to people
3 One of most serious in DEM region
2 1 Default
2efault
0 Default
1 Not considered a serious problem
1 No threat to people or economy
1 Not a serious threat
FEASIBILITY FOR TAKING ACTION
15—FEASIBILITY OF RECLASSIFYING GROUNDWATER
RANK SCORE:
Feasibility for Remedial Action
Need to Reclassifv Groundwater
ID Remedial action both feasible and desirable
3 Groundwater be RS GC
SourceName:
should relassified or
2 Default
Default
0
1 No remedial action recommended
1 No reclass. nor remedial action recommended
If 0
Control Number: J
Desirability of Remedial Action
Desirability of Reclassification
3 One of top regional office priorities
One of top reclassification priorities
County:
ODefault
25 Default
Ranker:
I Not a priority incident
1 Not a priority incident
Date:

FORhf APPROVED
*U. S. GOVERNMENT PRINTING OFFICE: 1978-724-845 OMB N0. 158-S78004 '
EPAForm7500-44A (6-78) STATL COPY
U.S. ENVIRONMENTAL PROTECTION AGENCY
SERIAL NUMBER
DATE PREPARED
SURFACE IMPOUNDMENT ASSESSMENT (SIA)
OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL
MONTH I DAY YEAR
SECTION II
038410
J
This form is Section Count
->a
INSTRUCTIONS: to be completed for one impoundment per site (facility) identified in 1, Location and 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 >
1. FACILITY IDENTIFICATION II. PURPOSE OF IMPOUNDMENT (Enter no. in block 23
IMPOUND-
MPOUND ,a.
t:�^°''
STATE
STATE s i,,:�o'- CNTY./CITY -. -. PLACE #`jo- 5 CATEGORY SIA SITE NUMBER �-� 'o 'ter a,-tr . $ 1. Waste Storage 2, Waste Disposal 3. Waste Treatment (Specify below) 4. Other (Specify below)
--
is :a MOM a>fi>fia -- z;: za MENT NO '�°6*
.:6.4�.,.: -o :...: a:�. �; . , �
r
'#
SPECIFY
a4
i .;;
n:
10x.a<> 18 ': 19 irf..`<<r
3 - 5 iz. 6 - 1 1 - 13 ,n'a f4 - - 21„n. 22 # 23 eea+?De' 24 34
. ...... ° :#:s :c ;�#.'.{;.: .$?.o n w�:da,- .... .>_...;t6, -
:.:..-ire'a., T.
III. IMPOUNDMENT DESCRIPTION
a, A e of impound.
g p
b. IS IMPOUNDMENT
c. If answer to III.b is
d. If answer to III.b is
e. Surface area of impoundment.
f. Surface area of�impoundments
mint in years,
PRESENTLY USED.
`yes', give no. of
'no', give lest year
at this site (in acres).
atthis
Z. Average influent into jhy$ impoundment (gallons per day and year of record).
1. Yes 2. NO
years in operation,
of operation.
(in acres)
JAW &e°v
#
i
J
$
%�
~
12
YEAR OF
..
EwI
,8fi::..:
.-.;
las ,o`#`3n`"'.i�`i:c:A
H. n: r:r,o-... ,.:
..
-..
CJ
1
-.
V
c
iz
,,
GALS./DAY
RE R
km
a
s{:
° ° °:
°°
35 36
a w,k: 37
38 39
r
40 - 43
44 - 49
50 - 56
i
22
a� a
23 - 31 :#� te a 32 35
III. IMPOUNDMENT DESCRIPTION (Continued)
h: Average effluent forte impoundment (gallons per day and year of record).
i. Avers ge daily influent for llimpoundments at this facility (gallons per day and year
j. Average daily effluent removed fromg" impoundments and discharged to streams, lakes,
of record).
etc, (gallons per day and year of record). -
'" t
YEAR OF
YEAR OF
YEAR OF
GALS./DAY
GALS./DAY
GALS./DAY
RECORD
RECORD
RECORD
44
t -.'a arj:
45 - 48
�' sax?: 49 - 57
d"co aro ;i 58 - 61
ic.'a''°:y 3" 62 - 70a,?f'd+o- --
71 - 74
...
a(,* z:.0:.0 ,0..
....
co- s. :.a'd<ro
o.- .. ,.
,..
Kr otco->saA(O..ro.,:
III. IMPOUNDMENT DESCRIPTION (Continued)
k. TYPE OF BOTTOM LINER (Enter no, trom the types listed into blocks 23 and 24.)
' IF CLAY LINER NO. 2,3 OR 4 IS SELECTED, GIVE THICKNESS IN INCHES (Enter in blocks 25 thru 27.)
1. FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER
01. None 04. Chemically Modified Clay 07. Metal 10. Buty! Rubber Sheeting 13. Chlorinated Polyethylene
(in blocks 40 thru 45) AND TYPE (in block46) OF LIVESTOCK.
02. Clay 05. Concrete 08. Polyethylene 11. Hypalon Sheeting 14. Other Membrane type (Specify in blks. 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.)
,ds_ r:'• • : .. iiN;'w # -'� � ar eco--�;_-_, ':',�:A�>_ '� '-Y �cw.-'"'
.
/�L'.
'<f.
s'cL�„,c_'�,�x,cbar+ " :,`#r',a.t;;?:-;
':�:..iw.,.
°.,..
/l/(�l.
:'a'A...':y,'',
xr ?9i^at'�''�s�.. '� o*io s�o-�x:#�,ss d&{a°4
<: '-::ac_aa*+r_"::..,.c1a'�-
�i„:�8-.f.(:3�,rAade}-o-::c,xo.c t.-2a.:,
:
t6oicK'{6:s9''ct4na.,'1�..'
za'
7l622
c 7,`
' .ws#,:x,-0- ::.- `.`. : � r`,h#,.r,.«,"
.vaxc,s,-',+--.x'.a.-o-:..r'ta..n-r..
�#,vd".:<:(:,:>�a,�.r:'':B.
-
`:dr°o`-"�det#4-xii.0.r.:...8.`.:;.'.�',.:
camat}r+.r td,aa0ac'*rr:,,.r.w„tt.rrtio.
:'>':.'.-_
c
-'-?
ar�.'..,£?. .
,. : $ .: .a°,.-:}.-::- ,
,:0:„�-,:s'iyc::c',..�i.bs-23 24 25 27 39
40 -
t'S{::"+.`castre>,. ,:6. s3:.k-;-..YaicX':soc`,'t
x&
>.,;�:-cta#.#r,E,s*a"rtir,
45 4
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGRADATION
. Nun'ber 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
.ring Fells 8850- 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 'yes', explain below.).m
mpoundent fif '0'
-
nter and go to 1. None 4. Monthly 7. Yearly
1. Yes 2. No 3. Unknown 4. Not Applicable
I. Yes 2. No 3. Unknown 4. Not Applicable (Can only be used when there
vestion V.b.).
- - - - - - - - - - - - - - - - - - - - - - - ---
- -.. are no wells within one mile of impotmdment.)-
- - - -
2. Daily 5. Quarterly S. Other (Specify in blocks 50 thru 61.)
EXPLAIN:
- - - - - - - - - - - - - -
EXP .
LAIIB-
3. Weekly 6. Semi -Annually
62
63
ca„tg4,:' 47 48 49 50 - 61 '"`''-'
VI. RATING OF THE GROUND -WATER CONTAMINATION POTENTIAL (See instruction manual EPA 570/4-78-003) VII WASTE IDENTIFICATION N
STEP i STEP 2 STEP 3 STEP 4 STEPS STEP 6 MISCELLANEOUS Enter the waste identification number
UNSAT. ZONE ONFIDENCE G.W. AVAIL. CONFIDENCE G.W. QUAL. CONFIDENCE WASTE } CONFIDENCE G W. CONTAM. HEALTH HAZARD CONFIDENCE IDENTIFIERS for Part Vi, Step 4.
POTENT 1 A
f#..
__ t.
✓ '";�.. -- o .}�':`.'�.'
-_fo ��..;r"a+.=
3
- ... �� : ';b .... ,._-_ -- idr -- -.;: ', v '.'o- - - ::. �� S -, .$k -,{;' '�.=�'t: .0`.1:.--. , ioc!xtt .--.-:'S
✓ �WLAXKR##n'- _- +� --o
-
:r:-_=-..::�.,
- N:.: , _ _ _
:�
�' : ,..:ate
xx:. .... #
22 23 '`° 2S t -�- 26 '�:----ci: ' `°�.-- �..?5... ::
0 ..,. 0'p:,: 24 ;:?t.' - 27 .s=" :'s 28 - 29 --.pt 30 . , , . 3 1 ar'-r. -, 32 x" "moi ,_,-_= 33 34:: Ra 38 40 s,., . 41 44
xi..s4Lo-`?t : w,.-. .,a. - >a% .............�0 nxi,..- ..>n�•ar o ...esu ,i>~,F:.:...co--=-^'ac aYo-z ,:�de.i0
.. .. ...... .. 0�oi, _xi.�;ft ,nr 35 36 `° 37 ,:,...: ...... - .* ..... - ..
EPAForm7500-44A (6-78) STATL COPY

'.I)ATL'Pr% 'PARLIT
*U. S. GOVERNMENT pIlINTING OFFICC: 1978-724-845 p„Ill NU. I58-S7SOOd
U.S. ENVINONMENTAI, PROT1r:C TION AG .NCY
SURFACE IMPOUNDMENT ASSESSMENT (SIA)
OPERATIONAL FEATURES OF THE IMPOUNDMENT AND GROUND -WATER CONTAMINATION POTENTIAL
SECTION 11
INSTRUCTIONS:'I'itie form is to be completed for orx impoundinctit per site (facility) identified in Section I, Locutiurt and Count of Impoundments 1�7 o:ln or for one
' 75 76 77 78 79 EO impvttndmcnt per site selected vin random Sampling prucr:dures. Complete multiple Choice questions by entaring lila code number prceadinc,,, the appropriate nnswCr,
S1HRIA1. NUA1131.W O
lJs� s�+cJ r p f/7
I. FACILITY IDENTIFICATION
I1. PURPOSE OF IM POUND NT {Enter no, in block 232
c. If answer to III.b is
'yes',
d. if answer to lll.b is
'no',
C. Suriacv arcu of impoundment.
f. Surface wren ofZ_11Impoundments
Clay 05'. Concrete 08. Polyethylene
_. 11. Hypalen Sheeting I4, Other Membra nt type (Specify In blks. 28 -3-),.)
mcsil in yeah.
es' Iva no, of
S
_
IMPOUND
at this site fin autos
f ),
Average influent into Impoundment pitons Cr do and year of rvco:d
kS• S' JbJ p^ (g P Y y )r
I. Yes 2.' NO
STATE
of operation.
CNTY./CITY
OF
PLACE
CATEGORY >.
SIA SITE NUMBER
'{
I. Wnsty Storage 2. Waste Disposal 3. Waste Treatment (Specify below) 4. Other (Specify below)
YEAR OF
w;
P.45/DAY
MENTNO.
GALS.IDAY
JYEAR
} rte^
GALS./DAY
22 ' 23 24
L,:
25 27
`
26 39 ?c x
y Y X '# 40 45 r e s. °� ay '
.e
-
SPECIFY
RECORD
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGP.ADA'1'ION
Nxunbm.r of muni
RECORD
_
a. IIAVL SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN
b. HAS THE CROUND-WATrR QTIALITY OF DRINKING WATER WELLS IN Tllgis,i
.sill we113 usso-
MONITORING WLLI.S.
013S:-RVB1) IN ANALY`RS FROM MONITORING WEGIS7 (If 'yus', vxpluin
AREA 131 EEN ADVCRSGLY AFFECTED DY SLEPAGE PROM TIIIS
atv.l with title
RECORD
IAIPOUNDAIL• NI'i (If 'yos'r explain beluw,)• '- •-` -'i+••
-
=v pnslmenl (if '0'
t.r and go to
36 - 44;
1. Yes 2. No 3. Unknown 4. Not Appllcul,lo
RECORD
izN 49 57
58 - 61
62 - 70s :*<; 71 f74
tib=
35 36
t 37 {
- n
38 39
2
... '.
3 - 5
.-`f
6 - 19 xi„'
11 - 13 {---�`s-
14 - 1B `�, .::
19 - 2r
.;3..
°2
_<,f
ar �'8 ri- 23
,e --'�
24 - 34•az._; roTx�-'.'';°.
III. IMPOUNDMENT DESCRIPTION.
Abp or impoumi
b• IS I%iPOUNAMF:NT
PRESENTLY USED?
c. If answer to III.b is
'yes',
d. if answer to lll.b is
'no',
C. Suriacv arcu of impoundment.
f. Surface wren ofZ_11Impoundments
Clay 05'. Concrete 08. Polyethylene
_. 11. Hypalen Sheeting I4, Other Membra nt type (Specify In blks. 28 -3-),.)
mcsil in yeah.
es' Iva no, of
S
give Inst year
Y
at this site fin autos
f ),
Average influent into Impoundment pitons Cr do and year of rvco:d
kS• S' JbJ p^ (g P Y y )r
I. Yes 2.' NO
years In operatlon.
of operation.
(in acres)
OF
'{
YEAR OF
w;
P.45/DAY
GALS.IDAY
JYEAR
} rte^
GALS./DAY
22 ' 23 24
L,:
25 27
`
26 39 ?c x
y Y X '# 40 45 r e s. °� ay '
.e
-
- 3...,'§
RECORD
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGP.ADA'1'ION
Nxunbm.r of muni
RECORD
_
a. IIAVL SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN
b. HAS THE CROUND-WATrR QTIALITY OF DRINKING WATER WELLS IN Tllgis,i
.sill we113 usso-
MONITORING WLLI.S.
013S:-RVB1) IN ANALY`RS FROM MONITORING WEGIS7 (If 'yus', vxpluin
AREA 131 EEN ADVCRSGLY AFFECTED DY SLEPAGE PROM TIIIS
atv.l with title
RECORD
IAIPOUNDAIL• NI'i (If 'yos'r explain beluw,)• '- •-` -'i+••
-
=v pnslmenl (if '0'
t.r and go to
36 - 44;
1. Yes 2. No 3. Unknown 4. Not Appllcul,lo
RECORD
izN 49 57
58 - 61
62 - 70s :*<; 71 f74
tib=
35 36
t 37 {
- n
38 39
40 43
44 49
50 55'€
22 c + 23 31 .;a " 32 35
III. IMPOUNDIIL'NT DESCRIF'rION (Continued)
Avera a effluent for L Impoundment gallons per da and
C th;, ( y year of record),
i. AvernFe 4N.Ry Influent for -.Il Impoundments at this facility (gallons per day and year
j. Average dniIy effluent removed from r„Limpoundments and discha bed to stream;, Sakes,
(in blocks 40 thru d5) AND TYPE (in bleck4L1 OF LIVESTOCK. r
of record).
eta, (gallons per day and year of record).
Clay 05'. Concrete 08. Polyethylene
_. 11. Hypalen Sheeting I4, Other Membra nt type (Specify In blks. 28 -3-),.)
1. Cattle 2. Ilous 3. Sheep 4. Poultry S. Other
3. Bentonite Modified 06.. Asphalt 09. Plasticized PVC 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39.)
YEAR OF
�]
OF
'{
YEAR OF
w;
P.45/DAY
GALS.IDAY
JYEAR
} rte^
GALS./DAY
22 ' 23 24
L,:
25 27
`
26 39 ?c x
y Y X '# 40 45 r e s. °� ay '
.e
-
- 3...,'§
RECORD
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGP.ADA'1'ION
Nxunbm.r of muni
RECORD
_
a. IIAVL SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN
b. HAS THE CROUND-WATrR QTIALITY OF DRINKING WATER WELLS IN Tllgis,i
.sill we113 usso-
MONITORING WLLI.S.
013S:-RVB1) IN ANALY`RS FROM MONITORING WEGIS7 (If 'yus', vxpluin
AREA 131 EEN ADVCRSGLY AFFECTED DY SLEPAGE PROM TIIIS
atv.l with title
RECORD
IAIPOUNDAIL• NI'i (If 'yos'r explain beluw,)• '- •-` -'i+••
-
=v pnslmenl (if '0'
t.r and go to
36 - 44;
1. Yes 2. No 3. Unknown 4. Not Appllcul,lo
45 - 48
izN 49 57
58 - 61
62 - 70s :*<; 71 f74
W _ _ - ^ -_. ^ ^ ^ are nu worts within one Mlle of hapotrncinront.)
- - ^ - ^ T T _
2. Dally 5. Quarterly 8. O1hcr (Specify to blocks 50 thru til.)
- n
EXPLAIN:
T
III. I%IP0UND ,4ENT DESCRTPTION (Continued) 1'r
TYPE OF 130TTONI LIVER (Enter no. tram the types listed Into blocks 23 and 24.)
IF CLAY LINER NO. 2,3 OR 4 IS SvLECTED, GIVE 'THICKNESS L3 INCHES (Enter in blocks 25 tf.ru 27.)
1. FOR AGRICULTURAL IMPOUNDMENT GIVE AVERAGE DAILY NUMBER -
None 0.1;:' Chemically Modified Clay 07. Metal 10. Dutyi E,sirber Sheeting 13. Chlorinated Polyethylene
(in blocks 40 thru d5) AND TYPE (in bleck4L1 OF LIVESTOCK. r
Clay 05'. Concrete 08. Polyethylene
_. 11. Hypalen Sheeting I4, Other Membra nt type (Specify In blks. 28 -3-),.)
1. Cattle 2. Ilous 3. Sheep 4. Poultry S. Other
3. Bentonite Modified 06.. Asphalt 09. Plasticized PVC 12. Ethylene Propylene 15. Other (Specify in blocks 28 thru 39.)
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'{
O
6 #rY
,s #
} rte^
22 ' 23 24
L,:
25 27
`
26 39 ?c x
y Y X '# 40 45 r e s. °� ay '
.e
-
- 3...,'§
IV. GROUND -WATER MONITORING
V. GROUND -WATER DEGP.ADA'1'ION
Nxunbm.r of muni
b. FREQU`LNCY OF G1:OU\'i)-WATER QUALITY SAhIPLING FROM
_
a. IIAVL SIGNIFICANT CHANGES IN GROUND -WATER QUALITY BEEN
b. HAS THE CROUND-WATrR QTIALITY OF DRINKING WATER WELLS IN Tllgis,i
.sill we113 usso-
MONITORING WLLI.S.
013S:-RVB1) IN ANALY`RS FROM MONITORING WEGIS7 (If 'yus', vxpluin
AREA 131 EEN ADVCRSGLY AFFECTED DY SLEPAGE PROM TIIIS
atv.l with title
snd dosrribe bolow huty thv 01v svus corructud.)
IAIPOUNDAIL• NI'i (If 'yos'r explain beluw,)• '- •-` -'i+••
-
=v pnslmenl (if '0'
t.r and go to
1. None 4. Monthly 7. Yearly
1. Yes 2. No 3. Unknown 4. Not Appllcul,lo
' "* i`ii•
1. Yes 2. Nu 3. Unitnown •1. Not Apptlrnble (Can onty be used when rhury ..'d
W:•tiort V.b.),
-• - -^ - ^ - ^^ -• ^• •- -• -- _ ,. ,,.. - ^
q
W _ _ - ^ -_. ^ ^ ^ are nu worts within one Mlle of hapotrncinront.)
- - ^ - ^ T T _
2. Dally 5. Quarterly 8. O1hcr (Specify to blocks 50 thru til.)
1.S"ti7i
EXPLAIN:
J. Weekly 6. Srml-Annually
47 40
49
'>i'
50 -- G1 s#':,"
62
G9 '
VI. 12A'rTNG OI'' 'I'l E GROUND -WATER R CONTAMINATION 110T1;NTIAL (Sce instruction moruml IhiYA 570/9-78-003)
VIi WAS'f'I; IDEN'rIPICATION
STEP I
STEP 2
STEP 3
STEP •I
1 STEP 5
STEP 6
MISCELLANEOUS
Lntor the waste Identification nuIll" r
s
c
IDENTIFIERS
for Part VI, Step {.
UNSAT. ZONE tLCONFIOENCE
G.W. AVAIL.
CONFIDENCE
G.W. QUAL,
CCN 1OI NC£
WASTE
ONFIOZ~NCE
G W. CONTAM.
F'OT NTA
HEALTH HAZARD
CONFIDENCE.
:..
22
.:
.. 24
... ¢, ....,..
25
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,.-
26 27 ....... ........
..,
'
. , :` =:, n.
29
..41m
..
x .?
':'" 32
k.<'-4
34
35 36..
:x e', e > 36 40
E...,.-,
ru>,,,.:o
44
r
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>., :,.,
v. :::,_
;; 28
., -
34 r., .,
-.. 31
s'
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:: 33
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37
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s: ,..
A Form 7500-44A (b•-78) �+,A C 0�}. ; .
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