Spill - Template

Bruggeman Farms - 310623046

1605 BIRCH AVE Larchwood, IA 512410000

Lyon County

FO 3

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

092203-AHB-1406

Spill Location:

43.418360, -96.486910

Spill County:

Lyon

FO 3

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 10
Tier: 99
Range: 48
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
	Jim Bruggeman	Confinement w/ MMP	Owner
	Extended Ag Services	Confinement w/ MMP	Public Contact

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

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
7/24/2009	Residents evacuated from house. House ventilated. Owner plans to remove UST and replace with AST. Entire propane system will then be checked for leaks. During UST removal soil will be sniffed for vapors.	DNRHSIADMIN

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

Bruggeman Farms - 310623046

1605 BIRCH AVE Larchwood, IA 512410000

Lyon County

FO 3

Edit Facility Location

Generate Letter Template

Facility Note

Incident Report

Responsible Party

Material Information

Revise Open Text File

Public Water Suppliers

Compliance Tracking

Possible Facility

Public Water Supply: Surface Water