CDRL_A011_TAB_Spill_Report_Form.doc
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- Aerial Targets
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- FA4890-14-R-0012
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Aerial Targets PWS App B CDRL A011 Spill Report Form
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CDRL-A011 Spill Report
Spill Report Form
Site Reporting Spill:
Reporter's Name, Organization, Duty Phone:
Date and Time of Release:
Location of release:
| Notification of Host Base Fire Department |
| Yes |
| No |
| Notification of Host Base Environmental Flight |
| Yes |
| No |
| Notification of National Response Center: |
| Yes |
| No |
| Notification of State Environmental Regulators: |
| Yes |
| No |
Equipment/Facility involved:
Root cause of release (when determined, not necessary with initial report):
Type of material released:
| Release Classification (circle one) |
| Class I |
| Class II |
| Class III |
Class I - Involves an area less than 2 lineal feet in any plane dimension
Class II - Involves area not over 10 lineal feet in any plane dimension, or not over 50 square feet, and not of a continuous nature
Class III - Involves an area over 10 lineal feet in any plane dimension, or over 50 square feet, or of a continuous nature
| Estimated quantity in gallons: |
| Released: |
| Recovered: |
Spills on a hard surface: 2 ft. diameter = .25 gal; 4 ft. diameter = 1 gal; 6 ft. diameter = 2 gal; 8 ft. diameter = 4 gal; 10 ft. diameter = 6 gal
Corrective action taken:
| Was the release contained on a hard surface (concrete, asphalt)? |
| Yes |
| No |
| Est. Quantity (gallons) |
| Did the release enter the storm drain or surface water? |
| Yes |
| No |
| Est. Quantity (gallons) |
| Did the release enter the sanitary drain? |
| Yes |
| No |
| Est. Quantity (gallons) |
| Did the spill reach and soak into any soil? |
| Yes |
| No |
| Est. Quantity (gallons) |
| Was the spill cleaned with in 24 hours? |
| Yes |
| No |
| Did the process owner have sufficient cleanup capabilities? |
| Yes |
| No |
| Is the spill reportable? |
| Yes |
| No |
| Any continuing threat to the environment? |
| Yes |
| No |
Estimated cost to cleanup (including man hours):
File details come from the government source that posted it. Updated .