Spill - Template

Iowa Methodist Medical Center - 310485602

1200 Pleasant St Des Moines, IA 50309

Polk County

FO 5

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

030514-DLP-1200

Spill Location:

41.590000, -93.630000

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:
Tier:
Range: 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
IMMC/UNITY POINT HEALTH DSM	UST	Owner
GLENN LOVE	UST	Public Contact
TB CRAICI	UST	Legal Operator
WESTFORK SCHOOLS	Leaking UST	Public Contact
WESTFORK SCHOOLS	Leaking UST	Legally Responsible Entity

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
3/7/2014	Fire Department and Environmental contractor placed absorbent down to recover ponded product in the parking lot. Storm drains on hospital property leading to storm water pond were flushed with rinsate captured. Small sheen accumulated at closed slew gates assoicated with storm sewer outfall. R.P. was asked to have enironmental contractor recover what product they could prior to opening slew gates.	DAVID PERRY

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

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Iowa Methodist Medical Center - 310485602

1200 Pleasant St Des Moines, IA 50309

Polk County

FO 5

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Public Water Supply: Surface Water