Spill Report

Requirements & Guidelines [Ref. 40 CFR §300.405]

  • Complete this form whenever a hazardous substance, petroleum product, or hazardous waste is spilled or released to the environment.

  • Environment means navigable waters, surface waters, storm sewers, drinking water supply, land surface, or ambient air.

  • Environment does not include spills or releases to a laboratory room, secondary containment system, or other non-permeable structure which is remediated in a timely manner.

  • If a release to the environment exceeds the applicable Reportable Quantity (RQ) identified in Appendix A of 49 CFR §172.101or the release is a petroleum product which reaches waters of the State (e.g., storm sewers, streams, rivers, oceans) then the release must be reported to the National Response Center (NRC).

  • Maintain completed spill reports for the lifetime of the facility.
QUESTION RESPONSE QUESTION RESPONSE
Time/Date of Spill   Common Name of Material Spilled  
CAS Number, if Applicable   Quantity of Material Spilled  
Direction & Distance of Spill   Quantity Determined by (est., calc)  
Duration of Spill (immediate, 1 hour)   Physical Location of Spill  
Name of Water Body Affected   Weather Conditions  
Containment Method Used   Cleanup Method Used  
Characterization of Cleanup Material   Was RQ Exceeded  
Description/Cause of Spill  
Name of Individual Reporting Spill  

Agencies/Individuals Notified (Include Date/Time of Notifications)

Supervisor/Facility Mgr. for all Spills

  
NRC 800/424-8802 if RQ Exceeded  
Others Notified  
Individual Completing Report   Date/Time Report Completed