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REPORT ~OF UNDESIRABLE EVENT `'- <br />y rl n ,/ C <br />DATE/TIME OCCURRED: ~~~/-_~_OOl+• DATE/TIME REPORTED BLM: ~tC/~cc 6~L-~71a'~A <br />/ Ta24e1 ~ RJy1sfF la7-17 <br />LOCATIONS~1%$// trQtr, Sec. ~~, T. IS. , R. `fgly (p~`~' Meridian <br />County: ____ ~ ~g/y„~,p _. State: G'o%Y~c~O ,/ ,,// // <br />WELL/FACILITY NUMBER: /T'o~(~ OPERATOR: ~~iTe ~,7/Y/Z /VtG~e~~TG <br />;SURFACE OWNERSHIP: ederal~ Indian Fee SLaLe <br />LEASE NUMBER:_ ~_-Q ~~ _ UrIIT rfAMEiCa NUMBEF.: <br />TYPE OF EVENT: Blowout Fire taLallcy Injury Properly Damace <br />Oil Spill Saltwater Spill Tonic Fluid Sniii Gas VanLir.c <br />OiliSalLwater Spil:i Oil,iTo:cic Fluid Sni1l <br />t er (SPeciiyi - .~I'C•J~rawr ~,9uc/L ~"~1~u4,~~ c~~yc~ L~~~c~~' _ <br />p C/ UIt 9 <br />CAUSE OF EVENT : _ _ ~ L'~c~~ G~-t mH ~ticl S~W 4~~^' /~' %'~ ~J~t ~ `L"`-~~ <br />i~~GJi?~. ~Di^^ ~[lJ_~-g.~ _~LC .,cJt'd Ccc.7` r QG /b s ~ !k~ ;/e) i!*~_d /c'_~ i~ . <br />' ~ --- ^ <br />VOLUMES OF POLLUTANTS: DiscnaraediConsumed: 0~~~ ~%''^-~ <br />ftecovered:___ _(~O~~uJ2~-~•~/ <br />TIME REQUIRED TO CONTROL EVP:DIT i in Hours i : ~~ /~u.',b_ _ _ _ _ __ <br />ACTION TAKEN TO CO^NTROL EVENT, uESC IPTIOIi 'F ~.MAGE, CpLG:,ri liP eRCEuURES // <br />AND DATES : ec~,r2 G.'%J _~/~~~_1~._ ~L _e=._-_'~`~.J~ _~i11 ~~ 6f1~_.L'Yi..kc~v_t~ <br />GCU ~bGP~- ~ ~/~.C.1un..T~`Q~ !(lU / /G,SI~ <br />CAUSE AND EXTENT OF PEkSONNI3L IIQJURY: ~(/~~ <br />OTHER FEDERAL, STATE AND LO~'AL GOVERNriEDIT AGEf'ICIES tdGTIFIED: ~~J`-~-tu'~ <br />ACTION TAK N 0 EVENT RECiJk Eric /vd~i~}+~.°~d. ~~? -~-*a'LJ j~.J ~~ <br />GENERAL REMARAS : ~_~ ~ ~ov5. uJ~ i~ ~`'^",J~' ~ ~c""d~~ <br />---~ -P-r~~__w-~..ccc« 7~~- S~~Z~~,~-~..UU~e~~ ~' ~Softv/L <br />RECEIVED BY: _ ____ ______ __ _ _ _ _ S, /~~ <br />(Name) 7~' <br />(Title) <br />Date: <br />