2011-06-24_PERMIT FILE - M2011029

• Permit No: M2011029
• IBM Index Class Name: PERMIT FILE
• Doc Date: 6/24/2011
• Doc Name: Confirmation of notice delivery
• From: Jubilee Venture, LLC
• To: DRMS
• Email Name: DMC
• Media Type: D
• Archive: No

Date of Spill:
Time of Spill:
SPILL REPORT FORM
min t`
*AWN ird
Date of Spill Discovery:
Time of Spill Discovery:
Name and Title of Discoverer.
Type of material spilled and manufacturer's name:
Legal Description of spill location:
Directions from nearest community:
Estimated volume of spilt:
Weather conditions:
Topography and surface conditions of spill site:
Spill medium (pavement, sandy soil, water, etc.):
Proximity of spill to surface waters:
Did the spill reach a waterbody? Yes No
If so, was a sheen present? Yes No
Describe the causes and circumstances resulting in the spill:
Describe the extent of observed contamination, both horizontal and vertical (i.e., spill stained soil in
a 5 -foot radius to a depth of 1 inch):
Describe immediate spill control and /or cleanup methods used and im plementation schedule: _
Current status of cleanup actions:
Name and Company for the following:
Construction Superintendent:
Spill Coordinator.
Enbridge Representative:
Person Who Reported the Spil I:
Environmental Inspector:
Form completed by: Date:
Spill Coordinator must complete this for any spill, regardless of size, and submit the form to
Representative within 24 hrs of the occurrence-