Information
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Field office
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Location
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Conducted on
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Reported by
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Phone Number
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Location
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Date & Time of the Spill
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Name of the Facility
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County
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State
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Legals
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What is the source of the spill?
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Spill Code Source
- 1. Wellhead
- 2. Flow line
- 3. Facility
- 10. Other (Description)
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If "Other" give a description.
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Spill Code Cause
- a. Hole in line
- b. Damaged/Failed valve
- c. Pressured up
- d. Tank overflow
- e. Stuffing box leak
- f. Hole in tank
- g. Blowout (well servicing)
- h. Blowout (drilling)
- i. Equipment failure
- j. Employee/contractor error
- k. Improper plugging
- z. Other (description)
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If "Other" give a description.
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What is the volume of release in bbls?
What is the fluid that spilled?
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Amount of oil?
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Amount of saltwater?
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Amount of chemical?
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What is the volume recovered in bbls?
How much fluid was recovered?
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Amount of oil recovered in bbls?
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Amount of saltwater recovered in bbls?
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Amount of chemical recovered in bbls?
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Is this release inside or outside the secondary containment area?
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If the spill is outside secondary containment was the release contained on the well site?
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What is the total volume outside secondary containment after the recovery process in bbls?
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Has any oil or saltwater reached a body of water?
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How many bbls of oil or saltwater reached the body of water?
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Have any fish/wildlife been affected by the spill?
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Has any livestock been affected by the spill?
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Describe the cause of the spill.
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What actions were taken to control the spill event?
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What actions were taken to remediate the affected area?
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Are there any further remediation recommendations?
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What actions have been taken to prevent this from occurring again?
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What person or agency was called?
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Date and Time
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Surface Owner
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Date & Time Surface Owner Contacted
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NRC Number (if applicable)
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Please provide a sketch of the spill and the affected area (if necessary)
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Spill Photos
