Spill - Template

Top Of Iowa Co-op - 311431242

101 North Park Lake Mills, IA

Winnebago County

FO 2

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

042603-EDW-0725

Spill Location:

43.419990, -93.537720

Spill County:

Winnebago

FO 2

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 3
Tier: 99
Range: 23
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:

Select	Name	Program	Type

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 employee tightened the soft valve on the nurse tank and the release stopped. There was no evidence of tampering with the nurse tank valves, nor evidence of appreciable release of anhydrous ammonia. All other valves were checked by the manager of the plant, and a meeting was held stressing the importance of checking the nurse tank valves, and the importance of notifying the DNR immediately of any releases.	DNRHSIADMIN

Comment:

Public Water Suppliers

Name	Supply Type	PWS ID	Operator: Name / Phone Number	Contacted

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

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Field Office Compliance - Spill

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Top Of Iowa Co-op - 311431242

101 North Park Lake Mills, IA

Winnebago County

FO 2

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Public Water Supply: Surface Water