Information
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YYK SPILL REPORT
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INSTRUCTIONS: Complete for any type of petroleum product or hazardous material/ waste or spill incident. GET MSDS NOW!!
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Date/Time of Report
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LOCAL ENVIRONMENTAL CONTACTS
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SWRMC Day (619) 556-1056 Evenings (619) 921-6249
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NASSCO Day (619) 864-2338 Evenings (619) 544-8444
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BAE Day (619) 818-7867 Evenings (619) 572-5488
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CMSD Day (619) 234-8851 Evenings (619)
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1. YYK Personnel involved in spill reporting: Name, Title, Phone Number
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2. YYK POC's Responsible for Spill Response: Primary: Ron Pivaro 619 512-6221, Sec: Carlos Sosa 619 770-7552
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3. General Spill Information:
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Common Name of Spilled Substance ---ATTACH COPY OF MSDS---
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Quantity Spilled (estimate)
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Image of Spill
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Date and Time Spill Began
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Time Spill Ended
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4. Spill Location and Conditions:
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Ship/Pier/Facility
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Weather Conditions:
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Was Spill to Water?
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Name of Water Body:
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Identify Discharge Point:
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Estimate the Depth and Width of Water Body
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Estimate Flow Rate (ie. slow,moderate,fast)
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Describe Environmental Damage (ie. fish kill?)
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5.Actions Taken:
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To Contain Spill or Impact of Incident:
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To Cleanup Spill or Recover from Incident:
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To Remove Cleanup Material:
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To Document Disposal:
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To Prevent Reoccurence:
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6. Reporting the Spill ---CALL YYK POC's IMMEDIATELY---
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List Alll agencies contacted; include names,dates, and phone numbers for people you spoke with:
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7. Additional Notes/Info or Witness
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7. NAME and SIGNATURE of INDIVIDUAL COMPLETING REPORT
