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Stormwater Management Plan <br />SPILL REPORT FORM <br />NOTES to General Contractor: <br />1) Contact the appropriate regulatory agency if the spill exceeds the applicable reportable <br />quantity. <br />2) Complete this form in full for each spill that exceeds 1 -gallon or exceeds the reportable <br />quantity for the Governing Agency and submit to the George M.L. Robinson or current <br />Storm Water Administrator. <br />3) Call George M.L. Robinson (720-641-2534), or current Storm Water Administrator <br />*see below <br />4) Transfer spill information to the Inspection Report (Appendix A) and resolve as <br />appropriate. <br />The Storm Water Administrator recommends taking photos to document spill clean-up measures and <br />saving the photos on-site. <br />*When calling the Storm Water Administrator to report a spill the General Contractor should leave <br />the following information: <br />1. Caller (full name & firm) <br />2. Caller Telephone Number <br />3. Spill Date <br />4. Type of material spilled <br />5. Amount spilled <br />5b. Was the amount above the applicable reportable quantity (Yes or No)? <br />5c. If yes, has the governing agency been notified of the spill (Yes or No)? <br />5d. If yes, what agency was notified (agency name and how notified): <br />6. Location of the spill on the jobsite <br />7. Did the spill impact surface water, leave the site, or enter an inlet (Yes or No)? <br />7b. If yes, elaborate on impacts to surface water, off-site area &/or inlet: <br />8. Has spilled material and contaminated media (soil, pavement, etc.) been removed and/or cleaned (Yes or <br />No)? <br />8b. If no, what additional measures need to be completed to remediate the spill? <br />9. Was the spill noted as a deficiency on the Inspection Report & resolved (or will be resolved) as soon as <br />practicable (Yes or No)? <br />9b. If no, add to Inspection Report as a deficiency & resolve. <br />10. Has the Spill Report Form been completed and submitted to the George M.L. Robinson or the current <br />Storm Water Administrator (Yes or No)? <br />I Ob. If no, complete and submit the Spill Report Form. <br />Sunrise Mining, LLC <br />Revised August 9, 2017 <br />Page 16 of 30 <br />