Spill - Template

Xpo Logistics Freight, Inc- Xdm - 310659779

5955 NE 19TH ST Des Moines, IA 50313

Polk County

FO 5

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

121114-SJM-0200

Spill Location:

41.670983, -93.587298

Spill County:

Polk

FO 5

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 12
Tier: 79
Range: 24 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
XPO LOGISTICS FREIGHT, INC	UST	Owner
	UST	Public Contact
XPO LOGISTICS FREIGH, INC.	UST	Owner
MATTHEW ZELLEN	General Permit #1 - Industrial Activity	Public Contact
JEFF SEXTEN	General Permit #1 - Industrial Activity	Public Contact
XPO LOGISTICS FREIGHT, INC.	General Permit #1 - Industrial Activity	Owner
CON-WAY FREIGHT, INC.	General Permit #1 - Industrial Activity	Owner
Matthew Zellen	General Permit #1 - Industrial Activity	Public Contact
MATTHEW ZELLEN	General Permit #1 - Industrial Activity	Public 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

File Name	File Type	File Date	Note

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

Xpo Logistics Freight, Inc- Xdm - 310659779

5955 NE 19TH ST Des Moines, IA 50313

Polk County

FO 5

Edit Facility Location

Generate Letter Template

Facility Note

Incident Report

Responsible Party

Material Information

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Public Water Suppliers

Compliance Tracking

Possible Facility

Public Water Supply: Surface Water