2015-03-23_PERMIT FILE - M2015008 ‎(2)‎

• Permit No: M2015008
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/23/2015
• Doc Name: Revisions Application
• From: Kirkland Construction
• To: DRMS
• Email Name: PSH
• Email Name: TAK
• Media Type: D
• Archive: No

Spill Report Form Continued
Spill medium (pavement, sandy soil, water, etc.):
Proximity of spill to surface waters:
Did the spill reach a waterbody? Yes No
If so, was a sheen present? Yes No
Describe the causes and circumstances resulting in the spill:
Describe the extent
of observed contamination, both horizontal and vertical (i.e., spill- stained soil in a 5 -foot radius to a depth of 1
inch):
Describe immediate spill control and /or cleanup methods used and implementation schedule:
Current status of cleanup actions:
Name and Company for the following:
Construction Superintendent:
SpillCoordinator:
i�vtl�aocd �o�xxt�urctiavc, U;V Representative:
Person Who Reported the Spill:
Environmental Inspector:
Form Completed By:
Date:
Spill Coordinator must complete this for any spill, regardless of size, and submit the form to the �uet&wd (%acu.tncrcf�aoi,
Zd;V Representative within 24 hrs of the occurrence.