Spill - Template

Ajinomoto Health and Nutrition North America, Inc - AHI - 310423788

1116 Highway 137 Eddyville, IA 52553-5001

Monroe County

FO 5

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

080902-DLP-0820

Spill Location:

41.145030, -92.649880

Spill County:

Monroe

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: 73
Range: 16 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
MARK WILSON	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO HEALTH AND NUTRITION NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO HEARTLAND, INC.	General Permit #1 - Industrial Activity	Legal Operator
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
ROB SAUNDERS	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO U.S.A., INC.	General Permit #1 - Industrial Activity	Owner
TRACY WILLIAMS	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
ROB SAUNDERS	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
DAVE SAMPLE	General Permit #1 - Industrial Activity	Public Contact
MARK WILSON	General Permit #1 - Industrial Activity	Public Contact
AJINOMOTO NORTH AMERICA, INC.	General Permit #1 - Industrial Activity	Owner
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
AJINOMOTO HEALTH & NUTRITION NORTH AMERICA INC	Water Use	Permittee
Ajinomoto Animal Nutrition North America, Inc.	Title V	Public Contact
Carl Haffner	Title V	Public Contact
Dave Sample	Title V	Public Contact
David Sample	Title V	Public Contact
	Title V	Public Contact
	Title V	Public Contact
	Title V	Public Contact
	Title V	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

Comments

Date	Comment	Commenter
7/24/2009	The source was reportedly stopped at the time of notification. Mr. Saunders stated that he has a vac truck in route to recover any free product from the grounds. Sump pits will be excavated on the grounds to recover any free product. The effected gravel will be flushed and rinsate recovered. The storm sewer will also be flushed and rinsate recovered.	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

Ajinomoto Health and Nutrition North America, Inc - AHI - 310423788

1116 Highway 137 Eddyville, IA 52553-5001

Monroe County

FO 5

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