Spill - Template

Agriland Fs, Canby - 311963998

1706 160th Street Casey, IA 50048

Adair County

FO 4

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

111412-ARM-1920

Spill Location:

41.420000, -94.570000

Spill County:

Adair

FO 4

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec: 7
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:

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
11/27/2012	Per Alison Manz - no water impacted. A dirt berm was constructed to prevent material from flowing down gradient to a grassed waterway. Material soaked up in the field needs to be excavated and/or tilled. A 30 day report is required.	KRISTI BURG

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

Agriland Fs, Canby - 311963998

1706 160th Street Casey, IA 50048

Adair County

FO 4

Edit Facility Location

Generate Letter Template

Facility Note

Incident Report

Responsible Party

Material Information

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Public Water Suppliers

Compliance Tracking

Possible Facility

Public Water Supply: Surface Water