Field Office Compliance - Spills Ad Hoc Report

Spill Number Received Date Received By Disovered Date Assigned To Reported By Anonymous DNR Observer Reported By Company Name Reported By Individual Name Reported By Individual Title Reported By Individual Email Reported By Phone Incident Information Location Address Location City Location County Location Field Office Location Latitude Location Longitude Location Township Location Range Location Range Direction Location Section Responsible Party Unknown Responsible Party Company Responsible Party Name Responsible Party Title Responsible Party Email Responsible Party Phone Responsible Party Address Responsible Party City Responsible Party State Responsible Party Zip Responsible Party Contact Responsible Party Contact Title Responsible Party Contact Email Responsible Party Contact Phone Responsible Party Contact Address Responsible Party Contact City Responsible Party Contact State Responsible Party Contact Zip Material Name Material Medium Material Quantity Material Units Transportation Fish Kill Continues Release Water User Notifications Incident Investigated Date of Investigation Compliance Determination Is 30Day Report Not Expected Spill Status Spill Closed Date