Spill - Template

Q.c. Coating, Inc - 311218821

3560 S 11TH AVE Eldridge, IA 52748

Scott County

FO 6

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

082503-RLT-1636

Spill Location:

41.622890, -90.570160

Spill County:

Scott

FO 6

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 26
Tier: 79
Range: 03 E
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
Stephen Berg	FO	Owner
Q. C. Coating, Inc.	FO	Legally Responsible Entity
QUAD CITY COATINGS	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	Hazmat cleaned up the material with floor dry and will dispose of the contaminated material at a later date. The employees emptied the remaining contents of the drum into the facility's degreaser. The RP called FO6 and left a message on the voice mail. The RP was given the 24-hour spill number for future notifications of spills.	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

Q.c. Coating, Inc - 311218821

3560 S 11TH AVE Eldridge, IA 52748

Scott County

FO 6

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Material Information

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Possible Facility

Public Water Supply: Surface Water