Audit

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
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.