Spill - Template

Ajinomoto Health and Nutrition North America, Inc - AHI - 310423788

1116 Highway 137 Eddyville, IA 52553-5001

Monroe County

FO 5

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

073010-AHB-1302

Spill Location:

41.140000, -92.650000

Spill County:

Monroe

FO 5

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 12
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:

Name	Program	Type
ROB SAUNDERS	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO HEARTLAND, INC.	General Permit #1 - Industrial Activity	Legal Operator
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO HEALTH AND NUTRITION NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
MARK WILSON	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
MARK WILSON	General Permit #1 - Industrial Activity	Public Contact
TRACY WILLIAMS	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
ROB SAUNDERS	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
Ajinomoto Animal Nutrition North America, Inc.	Title V	Public Contact
Carl Haffner	Title V	Public Contact
Dave Sample	Title V	Public Contact
David Sample	Title V	Public Contact
	Title V	Public Contact
	Title V	Public Contact
	Title V	Public Contact
	Title V	Public Contact

Material Information


Material: Medium: Quantity: Units:
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
07-30-2010\CMS MSDS.pdf	Report		CMS Material Data Safety Sheet
08-17-2010\CMS.pdf	Report		CMS MSDS

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
7/30/2010	Facility staff plan to repair fitting, pump material back into tank, and flush and vac the earthen dike area.	ADAM BROUGHTON

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

Ajinomoto Health and Nutrition North America, Inc - AHI - 310423788

1116 Highway 137 Eddyville, IA 52553-5001

Monroe County

FO 5

Edit Facility Location

Generate Letter Template

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Incident Report

Responsible Party

Material Information

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Compliance Tracking

Possible Facility

Public Water Supply: Surface Water