Attachment_F_-_Reporting_Incidents_Discovery_of_Pollution.pdf

PDF 61 KB Posted

Attached to
Grease Traps and Lift Station Maintenance with Septic Tank Pump-Outs
Solicitation number
Y23-103
Issued by
Orange County, Orlando City, Florida

About this file

This document is a 24-Hour Notice of an Incident or Discovery of Pollution form from the Florida Department of Environmental Protection, specifically Attachment F of a template for reporting environmental incidents. The form is designed to capture critical details about a potential pollution event, including the name and source of the incident, location, asset information, and basic incident description. The template requires details such as the quantity of substance released, recovered, and potentially discharged to surface water, with a specific note indicating "little or no potential risk to public health, safety, welfare."

The form provides a structured format for documenting environmental incidents, with highlighted fields for key information like facility name, discharge source, address, date and time of incident, and facility contact information. While the specific form is blank, it serves as a standardized reporting mechanism for environmental incidents, likely used by facilities to quickly notify state authorities about potential pollution events, with particular attention to discharges over 1,000 gallons that require additional state watch office and public notice tracking.

View the file

Other files

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

https://flo ridadep.gov / d leer /oer /content/reportable-incident

Please Note:

Media Contact:

Facility Name:

24-Hour Notice Of an Incident Or Discovery Of Pollution

Name Of Incident:

Discharge Source(Facility/lnstallation Name):

Address Or Locatiorn

Asset Information:

Nearest Physical Address to Blockage/Malfunction:

State Watch Office Case# (N/a for Discharges< 1,000 gal):

Public Notice of Pollution Incident ID# (N/A for discharges <1,000 gal):

Identification of Parties Notified of Incident:

Date and Time of the Incident or Discover

Incident Description:

The Approximate gallons release and recovered are estimated to be as follows:_gallons released, _gal recovered, 0 gallons unrecovered, and O gallons discharged to surface water.

There is little or no potential risk to public health, safety, welfare.

Facility Workorder:

Permitted Facility Name and Location:

Facility Contact:

ATTACHMENT F

File details come from the government source that posted it. Updated .