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