Incoming Report - Template

Incoming Report ID - 465948

Pb Leiner Usa - 311124833

7001 N. BRADY STREET Davenport, IA 52806

Scott County

FO 6

Site Name:

Address:

City:

County:

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Directions:

Section:

Tier:

Range:

Long:

Lat:

Incoming Report ID:

Program ID:

Incoming Report Type:

Received By:

Date Received:

Reported By:

Status:

Time Received:

Incident Start:

Sampling Required:

Incident End:

Parameters

From (location, equipment, stack):

Impact Water Of The State:

Quantity (# of gallons, % opacity):

Impacted Water Name:

Bypass Type:

Why did the occurrence happen:

What was done to stop the occurence:

Date Report Received:

Report Late:

Incomplete:

Year:

Period:

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Comments:

Report

Attached Files/Reports

Document Name	Type	File Date	Note
03-07-23 0833 EMail - Andy Murdock, PB Leiner USA to Jeff Thomann cc JPR - Written EE Report for 3-4-23 EE at EP-21.pdf	Report	03/07/2023	3/7/2023 0833 Email - Written EE Report for 3-4-23 EE at EP-21

File Name	File Type	File Date	Note

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Field Office Compliance - Incoming Report

Incoming Report ID - 465948

Pb Leiner Usa - 311124833

7001 N. BRADY STREET Davenport, IA 52806

Scott County

FO 6

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