Spill - Template

Casey's General Store 2518 - 310626929

404 LOCUST ST Lohrville, IA 51453-1047

Calhoun County

FO 3

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

122403-KAL-1516

Spill Location:

42.267780, -94.554010

Spill County:

Calhoun

FO 3

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 10
Tier: 86
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:

Name	Program	Type
CASEYS MARKETING CO	UST	Owner
	UST	Public Contact
THERESA WILLISON	UST	Legal Operator
CASEYS MARKETING CO	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	Local FD responded. Oil dry placed on spill and material picked up and placed in plastic bags. Norgarrt did not have the UST or LUST number for this facility at the time of the call.	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

Casey's General Store 2518 - 310626929

404 LOCUST ST Lohrville, IA 51453-1047

Calhoun County

FO 3

Edit Facility Location

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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