(25) J-0200000-05-3 Spill Response Form.pdf
PDF 190 KB Posted
- Attached to
- Multiple Services Federal contract opportunity
- Solicitation number
- N4008520R2557
About this file
This is a Spill Response Form template (Attachment J-0200000-05-3) used for MCBCL/MCASNR SPCC State Notification of Discharge Report for POL's (Petroleum, Oil, and Lubricants). The form is designed to document detailed information about spill incidents and subsequent response actions.
The form requires comprehensive documentation of spill incidents including: date and time of release, responsible party information, source and location of release, quantity and type of substance released, container details, sampling information, cause of release, scene description, mitigation actions, weather conditions, threatened areas, potential dangers, and required notifications. Additional specific requirements include documenting the presence of free product, proximity to water supply wells (within 1,500 feet), impact on surface water, precise latitude/longitude coordinates of the release, and directions to the spill site. The form lists John Hamilton ACAS Supervisor (910-451-1482) as the installation POC.
View the file
Other files for this federal contract opportunity
Show all 24
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT J-0200000-05-3
SPILL RESPONSE FORM
MCBCL/MCASNR SPCC State Notification of Discharge Report (POL's) Subj· ln•t•tl�llon POC/Phone Numbff: John H.1m�1on ACAS S..tll!MSOr Vl0-151-1482
I. Oate and Tima When AotNse Occur....utlitcD•ered
2. Ac1Mty/Rspanalble Pa,ty Originating Rein••
2a. Addre•• or Attl)O(IIIDi. Part)'
3. Source of Releaae (Storage Arn. Shop, Vltlllclt, tie)
•. Location or Splll (Bldg, Highway, Range, etc)
5, Oullntlly Aeleuecf (Gallona/1.lten, PoundllKJlogromaJ • It Unkn-n, lndlcalt Size of Conlamlneled Are•
6. T'll)e ol Subtlance ReleHod
7. Cantnln..- l1wolvtc1 (Drum, Bag, Storage Ttnk, l!lc)
a. Samples Taken (Val/No; Speclty Analyau ReqUHtecl/Pe,lo,med)
9. Cause of Rel•Ht
1 O. Reitan Scana Dnacrlpllon (Contanilnlted Arte, Path ofAtl .. at, etc) t I, Documont the Action TtkffllPJannecl to Mitigate the fleletH
12. On,SceM Wttlller/Wlnd (Temp, Humidity, Wind Vtloclt•. VislblMtw. etc:I
13. Aten Thrttttned/D;lmaged (Buch, Well1nda, W.itr lnlak., Aquifer. elc)
14. Polcnllal Dang..-. (Fire. E•ploalan, Toxic Vapor, ele)
IS. NoUllcaUon• Mada (NAC, Ccasl Guard MSO, EPA.
Stale. Local Agfflcy. etc) II. Ttlephonlc Report to NRC WHIWH not mada (NAC POC/Repon Numbffl
17, POC for A--1 (Peraon, AcHvlty. Phone Numbar)
11. Documeftt Any OU..r AtltVlnt lnlormallon ..-1nlng lotlltRtltlle
Document \ht Ptt1enca of FnNI Product CH Kno>m)
State how \he Aetuae w .. Dlsco•med
"'• Th•lr Any W•ler Supply Walla Whhln 1,500 Foat ol lhe t Yn, How Many Waler Supply Wtlll are within 1,liOO '"' >I lheAeliraaa
'fas any surf•c• water Impacted or the spill wllhln 100 feel ,r leH al any surface w,1.,7
.alllud• and Longlluda of Release Lautudt I I
Longltudt l (Decimal (DeclfMI
.,_,, .. 1 n...,, ... 1 Nreellon1 to Ina splll site
Mlp Attached
File details come from the government source that posted it. Updated .