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Spill Notification/Documentation Form <br /> Spill defined as"Minor" <br /> O11RAY SILVER MINES <br /> Report to Supervisor Immediately and Complete Form <br /> Part A: General Information Spill Date &Time ; <br /> Spill Quantity: Spill Substance <br /> Spill Location : Release to : [ ]Containment [ ]Stream [ ] Pond <br /> Spill Ongoing: [ ] YES [ ] NO [ ] Soil [ ]Air [ ]Ground water [ ]Other <br /> Spill Duration: [ ] Injuries [ ] Fatality <br /> Make additional notes on back of this form <br /> Nature of Spill&any environmental/health affects <br /> Measures taken to contain/reduce and/or clean up spill <br /> Corrective Actions/Follow-up <br /> Part B : Notification List Date,Time & Person Receiving Call <br /> Supervisor <br /> Doug Levesque-Site Manager <br /> (970)325-7241 ext 222 or(970)787-0015 <br /> CDPHE Emergency Response (877)518-5608 <br /> Spill greater than 10 gal not affecting water <br /> If Spill reaches surface water or ground water <br /> Environmental Protection Agency <br /> National Response Center (800)424-8802 <br /> Name&title of person reporting spill <br /> Signature &Date <br />