Form CalRecycle881 "Site Assessment Form" - California

What Is Form CalRecycle881?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CalRecycle881 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle881 "Site Assessment Form" - California

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State of California • Department of Resources Recycling and Recovery (CalRecycle)
SITE ASSESSMENT FORM
CalRecycle 881 (Rev. 1/17)
(Attach additional description or explanation as needed or include in comment Section VIII.)
Site name:
SWIS No.
I. Disposal Site Characteristics
A.
Waste Area(s) Dimensions
1. Area and volume:
acres
cubic yards
2. Estimate maximum depth of waste:
feet
3. Estimate average depth of waste:
feet
B.
Soil Type (check appropriate soil types)
1. Clay, silt, loam (low permeability):
Native
Cover
2. Sand, pebble (medium permeability):
Native
Cover
3. Gravel, cobble, rocks (high permeability):
Native
Cover
C. Mean annual precipitation:
inches
D. Estimated separation between waste and ground water :
feet
E.
Is waste area within a 100-year flood plain?
Yes
No
F. Show the following items on a site map(s):
1. Property boundaries
2. Waste disposal area(s) boundary
3. Structures on or within 1000 ft. of waste
4. Topographical Contours
5. Access points and roads
6. Site security systems
7. Surface water bodies and drainage patterns
8
Monitoring and control systems
9. Areas where landfill gas migration was detected
10. Areas where leachate migration was detected
G. Provide a chronological list of enforcement actions for the site:
H. Provide reference list of technical documents for the site (Give date and report, e.g. SWAT, Design, Control
System, and Monitoring Plans):
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Print
State of California • Department of Resources Recycling and Recovery (CalRecycle)
SITE ASSESSMENT FORM
CalRecycle 881 (Rev. 1/17)
(Attach additional description or explanation as needed or include in comment Section VIII.)
Site name:
SWIS No.
I. Disposal Site Characteristics
A.
Waste Area(s) Dimensions
1. Area and volume:
acres
cubic yards
2. Estimate maximum depth of waste:
feet
3. Estimate average depth of waste:
feet
B.
Soil Type (check appropriate soil types)
1. Clay, silt, loam (low permeability):
Native
Cover
2. Sand, pebble (medium permeability):
Native
Cover
3. Gravel, cobble, rocks (high permeability):
Native
Cover
C. Mean annual precipitation:
inches
D. Estimated separation between waste and ground water :
feet
E.
Is waste area within a 100-year flood plain?
Yes
No
F. Show the following items on a site map(s):
1. Property boundaries
2. Waste disposal area(s) boundary
3. Structures on or within 1000 ft. of waste
4. Topographical Contours
5. Access points and roads
6. Site security systems
7. Surface water bodies and drainage patterns
8
Monitoring and control systems
9. Areas where landfill gas migration was detected
10. Areas where leachate migration was detected
G. Provide a chronological list of enforcement actions for the site:
H. Provide reference list of technical documents for the site (Give date and report, e.g. SWAT, Design, Control
System, and Monitoring Plans):
II. Landfill Gas Migration
A. Status
1. Has an Air Quality Solid Waste Assessment Test (Air SWAT) been completed for the site?
Yes
No
If yes, describe results:
2. Have surface or structure landfill gas monitoring surveys been conducted for the site
Yes
No
If yes, describe results:
3. Does the site have a landfill gas monitoring system?
Yes
No
If yes, describe:
4. Does the site have a landfill gas control system?
Yes
No
If yes, describe:
B. Migration
1. Do surface methane emissions exceed 500 ppm?
Yes
No
Unknown
If unknown, conduct a field survey for presence of landfill gas.
If no, based on field observations or measurements, age, and moisture content of the waste and the existing cover
are surface emissions > 500 ppm likely to occur?
Yes
No
2. Has >1.25% methane by volume accumulated in on-site structures?
Yes
No
Unknown
If unknown, conduct a field structure survey for presence of landfill gas.
If no, based on field measurements, the age and nature of the waste, land use, and cover conditions, is landfill gas
accumulation likely to occur in structures on or around the site?
Yes
No
Reasons:
3. Do the methane concentrations exceed 5% at the site boundary?
Yes
No
Unknown
If unknown, conduct perimeter field survey for landfill gas migration.
If no, based on a perimeter field survey, age and moisture content of the waste, and the existing cover, is landfill gas
migration likely to occur beyond the boundaries of the site?
Yes
No
Reasons:
III. Leachate Seeps
A. Status
1. Does the site have a leachate control system?
Yes
No
If yes, briefly describe the leachate control system:
2. Does the landfill have an engineered lining system?
Yes
No
If yes, briefly describe the liner system:
3. Does the site have a final cover?
Yes
No
If yes, briefly describe the final cover and any agency approvals:
B. Migration
1. Is there any evidence of leachate seeps?
Yes
No
If yes, briefly describe and indicate if offsite:
IV. Burn Ash
A. Status
1. Is there burn ash at this site?
Yes
No
If yes, briefly describe:
2. Is there any exposed burn ash?
Yes
No
If yes, briefly describe:
B. Migration
1. Is there any evidence of burn ash off site?
Yes
No
If yes, briefly describe:
V. Surface Conditions
A. Is site access adequately restricted?
Yes
No
B. Is the waste adequately covered to prevent human contact?
Yes
No
C. Is the final drainage system for the site adequate to prevent erosion?
Yes
No
D. Is the final grading adequate to promote run off?
Yes
No
E. Are slopes greater than 3:1 (33% or 18 degrees)?
Yes
No
F. Are slopes greater than 1.75:1 (57% or 30 degrees)?
Yes
No
G. Comments:
VI. Postclosure Land Use
A. Has the land use of the site significantly changed since closure?
Yes
No
If yes, include or reference site improvement plans and answer the following:
1. Give the date that the improvements were constructed:
2. Have the improvements compromised the integrity of the final cover?
Yes
No
N/A
3. Has differential settlement affected the improvements?
Yes
No
B. Is there a proposed change in postclosure land use that may jeopardize the integrity of previously closed sites or
pose a potential threat to public health and safety or the environment?
Yes
No
If yes, briefly describe the proposed project:
C. Is there a postclosure land use tracking system?
Yes
No
If yes, describe the tracking system:
VII. Disposal Site Category (See Classification Chart)
Primary
A:
B:
C:
D:
U:
X:
Secondary
1:
2:
3:
VIII. Comments:
Prepared By:
Date:
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