Spill - Template

Ingredion Incorporated - 320148461

1001 1st st SW Cedar Rapids, IA 52404

Unknown County

Unknown

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

061505-TEM-1215

Spill Location:

41.967990, -91.667490

Spill County:

Linn

FO 1

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 28
Tier: 83
Range: 07
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
INGREDION CEDAR RAPIDS	Water Use	Permittee
PENFORD PRODUCTS	Water Use	Permittee
INGREDION CEDAR RAPIDS	Water Use	Owner
GEOMATRIX	Water Use	Legally Responsible Entity
INGREDION INCORPORATED	Water Use	Legally Responsible Entity
Ingredion Incorporated	Title V	Public Contact
Elaine Harmon	Title V	Public Contact
Kimberly Peterson	Title V	Public Contact
	Title V	Public Contact
David Brau	Title V	Public Contact
SCOTT MAKI	General Permit #1 - Industrial Activity	Public Contact
LIANE KROEMER	General Permit #1 - Industrial Activity	Public Contact
MICHELE IRMEN	General Permit #1 - Industrial Activity	Public Contact
MICHELE IRMEN	General Permit #1 - Industrial Activity	Public Contact
PENFORD PRODUCTS CO.	General Permit #1 - Industrial Activity	Owner
INGREDION INCORPORATED	General Permit #1 - Industrial Activity	Owner
SCOTT GROTH	General Permit #1 - Industrial Activity	Public Contact
LIANE KROEMER	General Permit #1 - Industrial Activity	Public Contact
PENFORD PRODUCTS CO.	General Permit #1 - Industrial Activity	Legal Operator
LIANE KROEMER	General Permit #1 - Industrial Activity	Public Contact
MICHELE IRMEN	General Permit #1 - Industrial Activity	Public Contact
Ingredion Incorporated	NPDES Industrial Contributor	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	Phone DNR emergency number if evacuation or further leak occurs. Send in written report.	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

Ingredion Incorporated - 320148461

1001 1st st SW Cedar Rapids, IA 52404

Unknown County

Unknown

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