Title Page

  • Document No.

  • STEMC Spill Report

  • Conducted on

  • Prepared by

  • Location
  • Personnel on site:

Oil Release Information

  • Date and time of spill notification:

  • Estimated or actual date and time of spill:

  • Cause of the spill (check one):

  • Transformer Serial No.:

  • Transformer Size/ KVA:

  • Transformer Manufacturer:

  • STEMC Company # :

  • At the time of spill, transformer was classified as (check one):

  • Document pictures of transformer condition, location and nameplate.

  • Was an oil sample taken if needed?

  • Estimated amount of oil released:

  • Description of contaminated areas:

  • Document pictures of contaminated areas.

Notifications and Clean up

  • NRC (1-800-424-8802) notified:

  • TDEC -EPA Region 4 (615) 532-0109 notified:

  • Will Site clean up be delayed due to emergency or adverse weather?

  • LEPC (county specific) notified:

  • Has spill boundary been identified and a 1 foot buffer been established?

  • Site clean up initiated:

  • Add media

  • Was an outside contractor used for the clean up? If yes enter name of contractor in the next field.

  • Description of clean up procedures :

  • Site clean up completed

  • Add media

Test Results, Storage and Disposal

  • Date and time transformer and/or soil was placed in containment room

  • List PCB Oil Test Results including ppm, sample no. and test date:

  • Date and time transformer picked up transformer for disposal or repair.

  • Add media

  • Date and time soil and debris picked up for disposal:

  • Add media

  • Completed By:

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