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?ZooZ-i1L( ? i ? SSS <br />1 "71 <br />FRa? : c71?e?JSI-I??V,?{IeJCo??,?,es / RECEIVED <br />NOV 0 7 2008 <br />v,.. _ - <br />Spill Notification Form avlsloN of <br />RECLAMATION MINING' F1 <br /> <br />FE <br />Part A: Basic Spill Data <br />Spill Type: Major / Minor Spill Date: l)sl08 <br />Type of Spilled Substance: Spill Time: /: 3S 9, <br />Quantity Spilled: -rgb Spill Duration: S ro ,?;???rs <br />Facility Name: Location of Spill: <br />FastPack System <br />- N? sqr A^ <br />is- ro.d p l <br />Owner / Company Name: Released to: [) Containment [ ] River <br />United Companies [ ] Pond [X] Soil [ j Air [ ] Ground Water <br /> [ j Other <br /> Nature of spill and any environmental or healthy effects:. - seal 1,j4s /a ra->> e"c-4 <br />?P.:.} §!; ?X'1'/„fl't M+:q.`?'. <br />? <br />? <br />J <br /> id,. ?q( <br />J,{,. 9`JU?f <br />?IC?ntE <br />y!1 {.+i'?alt^ <br />] Injuries [ j Fatalities <br /> Part B: Notification Checklist <br /> Notification Date and Time Name of Person the <br /> Recieved Call <br /> pill is any amount of petroleum product: <br /> olorado Department of `/Mo IC,11 44>ir#05 <br /> ublic Health and <br /> <br />r o' 4 r° , ,? e x- <br />11 <br />?v3-692-,e <br /> nvironment r <br />se, <br /> (877) 518-5608 a,009 ° o4 - S r <br /> Local Health Department I1W"s 10:0 0-n SwrG h <br /> ,15'y, - /goo <br /> Colorado Division of 610s ?'S5 G? IrG?'S r?G.?h?ll <br /> Minerals and Geology <br /> 303)866-3567 <br /> SHA <br /> 303) 231-5465 <br /> pill reaches. ground water or surface water: <br /> <br /> PA National Response <br /> enter (800) 424-8802 <br /> <br /> Form Completed By (Print Name): Sign an Date: <br /> <br />:E <br />ry <br />This form must be submitted to Enviromental Officer. A copy must be retained on-site and included with the SPCC Plan.