Spill - Template

Elanco- Fort Dodge Laboratories- 5th St - 311126322

800 5th. Street NW Fort Dodge, IA 50501

Webster County

FO 2

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

080212-SJW-0150

Spill Location:

42.520060, -94.207640

Spill County:

Webster

FO 2

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 13
Tier: 89
Range: 29 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
Boehringer Ingelheim Vetmedica Inc. (Main Plant)	NPDES Industrial Contributor	Owner
Jessica Moffitt	SM-80	Public Contact
ELANCO US INC.	General Permit #1 - Industrial Activity	Owner
ELANCO US INC.	General Permit #1 - Industrial Activity	Owner
FORT DODGE LABORATORIES	General Permit #1 - Industrial Activity	Legal Operator
MATT THRAMS	General Permit #1 - Industrial Activity	Public Contact
RODNEY KERN	General Permit #1 - Industrial Activity	Public Contact
BOEHRINGER INGELHEIM VETMEDICA, INC.	General Permit #1 - Industrial Activity	Owner
BOEHRINGER INGELHEIM VETMEDICA, INC.	General Permit #1 - Industrial Activity	Legal Operator
RODNEY KERN	General Permit #1 - Industrial Activity	Public Contact
FORT DODGE ANIMAL HEALTH	General Permit #1 - Industrial Activity	Owner
JESSICA MOFFIT	General Permit #1 - Industrial Activity	Legal Operator
ELANCO US INC.	General Permit #1 - Industrial Activity	Legal Operator
JESSICA MOFFIT	General Permit #1 - Industrial Activity	Public Contact
MATT THOMAS	General Permit #1 - Industrial Activity	Public Contact
MATT THOMAS	General Permit #1 - Industrial Activity	Public Contact
Boehringer Ingelheim Vetmedica Inc	Open Feedlot	Owner
Rodney Kern	Open Feedlot	Public Contact
FORT DODGE LABORATORIES, INC.	Minor Industrial	Owner
BOEHRINGER INGELHEIM VETMEDICA INC.	Minor Industrial	Owner
ELANCO FORT DODGE	Minor Industrial	Owner
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing Contact
	Minor Industrial	Mailing 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

Document Name	Type	File Date	Note
080212-SJW-0150.pdf	Report	08/02/2012	2012-08-31 written spill report

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
8/6/2012	Check river for impact in the morning. Per Scott Wilson	LORI RATTAY

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

Elanco- Fort Dodge Laboratories- 5th St - 311126322

800 5th. Street NW Fort Dodge, IA 50501

Webster County

FO 2

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Incident Report

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Material Information

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Public Water Supply: Surface Water