Spill - Template

Rembrandt Enterprises Inc (rembrandt) - 310343134

4787 140th Ave Rembrandt, IA 50576

Buena Vista County

FO 3

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

021411-AHB-1609

Spill Location:

42.823660, -95.131760

Spill County:

Buena Vista

FO 3

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec:
Tier:
Range:
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
Clint Payne	SM-80	Public Contact
CHACE DOYAL	General Permit #1 - Industrial Activity	Public Contact
BOBBY VARGASON	General Permit #1 - Industrial Activity	Public Contact
PATRICK BURGER	General Permit #1 - Industrial Activity	Public Contact
REMBRANDT ENTERPRISES, INC.	General Permit #1 - Industrial Activity	Owner
CHANCE GODDARD	General Permit #1 - Industrial Activity	Public Contact
Chace Doyal	General Permit #1 - Industrial Activity	Public Contact
REMBRANDT ENTERPRISES, INC.	Minor Industrial	Owner
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
Rembrandt Enterprises Inc	Water Use	Owner
Rembrandt Enterprises Inc	Water Use	Permittee
FACET NW INC	Water Use	Legally Responsible Entity
Rembrandt Enterprises Inc	Water Use	Owner
Rembrandt Enterprises Inc	Water Use	Permittee
Rembrandt Enterprises	Water Use	Legally Responsible Entity
JULIAN JOHNSEN	Non-Transient Non-Community	Legal Operator
REMBRANDT ENTERPRISES INC	Non-Transient Non-Community	Owner
REMBRANDT ENTERPRISES	Non-Transient Non-Community	Public Contact
Rembrandt Enterprises, Inc.	Confinement w/ MMP	Owner
Clint Payne	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
2/14/2011	Facility staff placed absorbent boom at the discharge to the stormwater pond, placed sand to contain the remaining material to the gravel drive, and placed absorbent materials on the spill itself. Will scrape contaminated gravel and containerize for proper disposal contaminated sand, gravel and absorbent materials.	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

Rembrandt Enterprises Inc (rembrandt) - 310343134

4787 140th Ave Rembrandt, IA 50576

Buena Vista County

FO 3

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Public Water Supply: Surface Water