Spill Or Incident Report Form (Page 2 of 2) in pdf

Spill Or Incident Report Form Page 2

6. Reporting the Spill:

Spills to water: Immediately call the National Response Center (1-800-424-8802), Emergency

Management (1-800-258-5990), and the appropriate Ecology Regional Office.

Spills to soil that may be an immediate threat to health or the environment (i.e., explosive,

flammable, toxic vapors, shallow groundwater, nearby creek, etc.): Call the appropriate Ecology

Regional Office immediately. If not immediately threatening, but may be a threat to human health

or the environment, report to Ecology within 90 days.

Note: Project specific permits may have additional reporting requirements.

List all agencies contacted; include names, dates, and phone numbers for people you spoke with:

_____________________________________________________________________________

Record ERTS #, if issued by Ecology: ______________________________________________

7. Person Responsible for Managing Termination/Closure of Incident or Spill:

Name and Phone: ______________________________________________________________

Address and Fax: _______________________________________________________________

8. Additional Notes/Information (if necessary):

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Spill Or Incident Report Form Page 2