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<br />
<br /> Part A: Basic Spill Data
<br /> Spill Type: Major / o SpiII Date: 6 - „" I - ~
<br /> Type of Spilled Substance: ~' ~"mom+~ al_-" Spt7l Time: Q ~ /1~
<br />
<br /> Quantity Spilled: ~ ~ - a S ~ ~ . Spili Duration: 3 - S
<br />~ eco n c~ S
<br /> Facility Name: United Companies n
<br />Location Of Spt71: ~r.Lrc1 ..~.[~v_ _
<br />•
<br /> Asphalt Plant $ 46 - 600 1.
<br />?• a,_ HwI 3.3 ~.,1.~ ~wee.in
<br /> Mess co ~ ~,r~
<br /> Owner /Company Name: Released to: (~]~Coatatnment [ ]River
<br /> United Companies of Mesa County [ ] poad (]Soil [ ]Air [ ]Ground Water
<br /> P. 0. Box 3609
<br /> Grand Junction, CO. 81502 (]Other
<br /> s• N e . -~ a I e e e-I z
<br />store of spill and an
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<br /> Part B: Notification Checklist
<br /> otification Date and Time ame of Person the
<br /> 'sued Call
<br /> amount of petroleum proddct: ' ~ `<:~•r ,,
<br />pinta y ; ~,~ ,~~ ~ ~~, .~h ,,~~~}. ,, ~;
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<br /> olorado Depar~ent of
<br /> blic Hesltb and
<br /> avironment
<br />~-~3-0{~ /;38P~`1• /\
<br />Jeff, /-Ir,.. ~i~~id.w.S
<br /> glHealth Departmwt
<br /> ~,~.~ u e„v..,+yy
<br /> (970)-ot44-6"Ifi6 6-o"cB-06 ~:'OP, ,
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<br />__Crr. a a VO ioe Md~~
<br /> ityof Col)brd./
<br /> 970)- 48'7- 3'7 ,~ / L'I2r(~
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<br /> bndo Division otlldiaerab •
<br /> as Geology -, /vlea n s
<br /> 03) 731.5465 (~ - ~'~j -(yr; ~; 4S~ ~'I on eS
<br /> pill reaches pronnd
<br />~ater o " ntia' ~ witer~: ' ~ ~~ { .~~;A'",?~ ,
<br /> ;
<br /> PA National Response
<br /> enter (800) 424-8802
<br />
<br />Form Completed By (Pr
<br />int Name): Sign and Date:
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<br />r'en-~- L4~ , 1 ~r-r- G ot3 d
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