Spill - Template

Gavilon Grain, Llc Dba Peavey Company - Masonville - 311385856

401 Gorden Street Masonville, IA 50654

Delaware County

FO 1

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

030102-MAW-1615

Spill Location:

42.480380, -91.593790

Spill County:

Delaware

FO 1

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 31
Tier: 89
Range: 06
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

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
7/24/2009	Upon my arrival at approximately 4:30 pm on March 1, 2002, I instructed Mr. Nelson to dike the area around the containment stricture to prevent contaminated water from leaving the site. A dike was constructed by 5:30 pm. This office was contacted on March 3, 2002 to report that UAP environmental staff would be on site March 4, 2002, to ensure no further release of contaminated water would occur at this site.	DNRHSIADMIN

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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Gavilon Grain, Llc Dba Peavey Company - Masonville - 311385856

401 Gorden Street Masonville, IA 50654

Delaware County

FO 1

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