Spill - Template

Love's Travel Stop #361 - 310659951

4400 S 22ND AVE E Newton, IA 50208

Jasper County

FO 5

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

012917-TAP-1856

Spill Location:

41.680000, -93.000000

Spill County:

Jasper

FO 5

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec:
Tier:
Range: W
Lat:
Long:

Responsible Party

Remove Facility

Is Individual

Unknown

Company:

Phone:

Email:

Address:

City:

State:

Zip:

Spill Contact

Name:

Title:

Phone:

Email:

Address:

City:

State:

Zip:

Select	Name	Program	Type
	LOVE'S TRAVEL STOPS & COUNTRY STORES	UST	Owner

Material Information


Material: Medium: Quantity: Units:

Transportation:

Fish Kill:

Continuous Release:

Date of Investigation:

Incident Investigated:

Status:

Compliance Determination:

30 Day Report Not Expected

Transferred To Contaminated Sites:

Report

Attached Files/Reports

Document Name	Type	File Date	Note
03-20-2017\012917-TAP-1856.pdf	Report		30 day

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
1/30/2017	Driver immediately contained the spill and applied absorbent to pooled product. Store manager assisted and disposed of absorbent material according to their protocol. ~tap	JESSICA ACKERMAN

Comment:

Public Water Suppliers

Name	Supply Type	PWS ID	Operator: Name / Phone Number	Contacted

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

Multiple Results Found

Field Office Compliance - Spill

New Material

Love's Travel Stop #361 - 310659951

4400 S 22ND AVE E Newton, IA 50208

Jasper County

FO 5

Edit Facility Location

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Facility Note

Incident Report

Responsible Party

Material Information

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Public Water Suppliers

Compliance Tracking

Possible Facility

Public Water Supply: Surface Water