Spill - Template

Agriland Fs, Canby - 311963998

1706 160th Street Casey, IA 50048

Adair County

FO 4

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

052311-MAC-1145

Spill Location:

41.416458, -94.565910

Spill County:

Adair

FO 4

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 5
Tier: 76
Range: 32 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:

Select	Name	Program	Type

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
casey052311.sp.agrilandfsfishkillnov.wilken.pdf	Report	06/12/2013	nov
casey052212.agrilandfsfollowvisitmemo.wilken.pdf	Report	06/12/2013	memo
casey061213.sp.agrilandfsvisitmemo.wilken.pdf	Report	06/12/2013	memo

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
7/7/2011	From report by Melodie Carr - DNR Fisheries staff conducted a dead fish count. Instructed Agriland FS that housekeeping practices must change. Will vrevisit facility to deal with other non-documented spils.	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

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Field Office Compliance - Spill

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Agriland Fs, Canby - 311963998

1706 160th Street Casey, IA 50048

Adair County

FO 4

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Public Water Supply: Surface Water