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}S°X~'-?:i~ ~ J- ~ ~ '~`,~ ~,4~u i •qt~l,^•-++~_!'. ' _~+, .ate..,-.ri,~~',~ r~_ c~ w_ =.r''.. r~,~ u ~1:~+}`~'. ~ r y ~y ~""''~~'~.,.-~~••~~ y ~,~. _ _ :.yam _- ~_~:.^'. ~-.~ ,~. .. - -~-:Y""~ -. - _ -:x~~~~' ...:~.~_ -_ - - .~ ~ _. _ - ter.. - 'r, ... REl?ORT OF UNDESIRABLE EVENT - DATE/TIME OCCURREL:~~~S~b3Cj DATE/TIME REPORTED BLM:~1_%/~. _~O~U LOCATION;~~/ G QtrQtr, Sec. ~~_, T. -, S-_, R. ('0 ~_ . , _. _ Meridian County:-_~~~t~.~-- -- State: _._.. --Q-- -- // ~~ QI WELL/FACILITY NUMBER: LCJ~!'V ~e~~i'~ OPERATOR:~4(~e 71~1!-?~l./(J~'f^F_"`ire SURFACE OWNERSHIP: Federal. Indian Fee State LEASE NUMBER:_-__~=_Q((_~;3~~__ UPIIT NAME/CA NUMBER:- __ TYPE OF EVENT: Blowout Fire Fatality Injury Property Damage i Oil Spill 31 rater~Di_11 Toxic Fluid Spill Gas Venting Oil/Saltwater Spill Gil/Toxic Fluid Spill Other (Specify) _-____-_ ___- -.... -... - //- _ o ... - - -- - / CAUSE OF VENT: JleM ,r...e.L„ ~/L, [cpSe Le02d ~Y%/ ~ S~`_6_ L-_ ~?_ Ly~~ils S-fc ,~/w~ Yu- ._ .. _. / rl'?- f"~"t-f~ ~3~dr 6 so~.,~~7'~ U Q/~pj~ ~ VOLUMES OF POLLUTANTS: Discharged/Consumed: ti ~~U __-._.._.._ kecovered'--- - - - ------ -(/- ----- -.. .-- 7 TIME REQUIRED TO CONTROL EVENT (in hours) : _ .,-OJ___- _ _- d-~L -;~ ~±+.>>± _?-d _ ACTIOtd TAKEN ~O CONTROL EVENT, LESCRIPTIOPI OF DA~MAG'E, CLEAN ,~r RCEDURES // AND DATES : e t u~iira~~~if~ ,<~ _ .coo ~ ° ~=vu~rr!~i~e..n...~_ n -"°. _ -- •V . C(~e-c~h err .xo 2r ~ ~L,,. _ G,ia--O~t__~~~ S~J. i ~jtl~/eti0y~/ fsc%~re~ Gi.•' aC.-~'G S ~ sc..-~~..~Gs3~~,nc,~`^-"~~J-bv.= j..,, zl_6 Q-__ CAUSE AND EXTENT OF PERSONN:SL INJURY: __-_ !"~J^-?-_,_ ____..____ OTHER FEDERAL, STATE AND LG~'AL GOVERNMENT AGENCIES NOTIFIEL:.-_C..~~pt'~a-tC~ ACT~I~O~N T~A~KEN TO PREVENT RECiJRRENCE: _ ___~e~vet~_ ~o-~-e. ..L~ ~'C~!^ ~??a-~`K/ GENERAL REMARKS : ,_ y~.~ru.,rl_~r/~ ~ _ _ ~~ie~L ~~~ P.ECEIVED BY• -- - - - -- (Name) Date: iTitle)