Spill - Template

Brew Oil #40 - 310540368

1001 S GRAND AVE Spencer, IA 51301-5722

Clay County

FO 3

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

080505-NAC-1115

Spill Location:

43.127050, -95.143750

Spill County:

Clay

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
WESSELS OIL CO INC	UST	Owner
WESSELS OIL CO INC	UST	Tank Owner
DYNO OIL CO., INC.	UST	Owner
DYNO OIL CO., INC.	UST	Legal Operator
BREW OIL LLC	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

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
7/24/2009	Contain and soak up spilled material with absorbents. Remove and properly dispose of all petroleum contaminated absorbents and soils.	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

Brew Oil #40 - 310540368

1001 S GRAND AVE Spencer, IA 51301-5722

Clay County

FO 3

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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