Spill - Template

Landfill of North Iowa - 311216623

15942 Killdeer Ave Clear Lake, IA 50428

Cerro Gordo County

FO 2

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

102111-KAL-1137

Spill Location:

43.125191, -93.300889

Spill County:

Cerro Gordo

FO 2

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 22
Tier: 96
Range: 21 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:

Name	Program	Type
Landfill of North Iowa	NPDES Industrial Contributor	Owner
Landfill of North Iowa Solid Waste Agency	Household Hazardous Materials	Legally Responsible Entity
LANDFILL OF NORTH IOWA	General Permit #1 - Industrial Activity	Legal Operator
BILL ROWLAND	General Permit #1 - Industrial Activity	Public Contact
BILL ROWLAND	General Permit #1 - Industrial Activity	Public Contact
LANDFILL OF NORTH IOWA	General Permit #1 - Industrial Activity	Public Contact
William Rowland	Title V / Minor EI	Public Contact
Hannah Dubbs	Title V / Minor EI	Public Contact
Kathy Paulson	Title V / Minor EI	Public Contact
	Title V / Minor EI	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
10/21/2011	Floor dry was applied to the spill. Some absorbants were left in place where diesel had soaked in to the soil a little bit more. Oil dry will be picked up this afternoon for disposal at the landfill.	KATHY LEE

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

Landfill of North Iowa - 311216623

15942 Killdeer Ave Clear Lake, IA 50428

Cerro Gordo County

FO 2

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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