Information

  • YYK SPILL REPORT

  • INSTRUCTIONS: Complete for any type of petroleum product or hazardous material/ waste or spill incident. GET MSDS NOW!!

  • Date/Time of Report

  • LOCAL ENVIRONMENTAL CONTACTS

  • SWRMC Day (619) 556-1056 Evenings (619) 921-6249

  • NASSCO Day (619) 864-2338 Evenings (619) 544-8444

  • BAE Day (619) 818-7867 Evenings (619) 572-5488

  • CMSD Day (619) 234-8851 Evenings (619)

  • 1. YYK Personnel involved in spill reporting: Name, Title, Phone Number

  • 2. YYK POC's Responsible for Spill Response: Primary: Ron Pivaro 619 512-6221, Sec: Carlos Sosa 619 770-7552

  • 3. General Spill Information:

  • Common Name of Spilled Substance ---ATTACH COPY OF MSDS---

  • Quantity Spilled (estimate)

  • Image of Spill

  • Date and Time Spill Began

  • Time Spill Ended

  • 4. Spill Location and Conditions:

  • Ship/Pier/Facility

  • Weather Conditions:

  • Was Spill to Water?

  • Name of Water Body:

  • Identify Discharge Point:

  • Estimate the Depth and Width of Water Body

  • Estimate Flow Rate (ie. slow,moderate,fast)

  • Describe Environmental Damage (ie. fish kill?)

  • 5.Actions Taken:

  • To Contain Spill or Impact of Incident:

  • To Cleanup Spill or Recover from Incident:

  • To Remove Cleanup Material:

  • To Document Disposal:

  • To Prevent Reoccurence:

  • 6. Reporting the Spill ---CALL YYK POC's IMMEDIATELY---

  • List Alll agencies contacted; include names,dates, and phone numbers for people you spoke with:

  • 7. Additional Notes/Info or Witness

  • 7. NAME and SIGNATURE of INDIVIDUAL COMPLETING REPORT

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