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<br />REPORTING INFORMATION <br />Notification Dale <br />PM ð <br />Repo B / ¡¡lie <br />C,C), D..:...., <br />OrganiZation <br />rJ <br />treel AddCll$s <br /> <br />~13/1998 15:55 2328537 <br /> <br />~ 'INITIAL INCIDENT REPORT <br />J Emergency Response Seclion <br />Slale Form 13490 (R313 - 98) <br />Indiar\3 OepL 01 Environmental Management <br />2525 Nonh Shadeland Avenue <br />'-- P.O. Bo,\ 6015 <br />Indianapolis. Indiana 4620(H;015 <br />204-Hour Emergency Reporting Number <br />311/Z33-5PIL 177461 <br /> <br />,r <br />Inddenl TIme <br />AM <br /> <br /> <br />.e,sv <br /> <br />.LLJE:.IT U'l"tl" <br /> <br /> <br />4 Air <br />5 ComplainlS <br />& Other <br />In¡Ual Only <br />Ves <br />No <br /> <br /> <br /> <br />CIt¥ I Slate / ZIp Coda <br /> <br />I RaspoMible PartY <br />2 Fed. GoYI Agency <br />3 Slate GOY'I Agency <br />4 L.ac;aI GOY'I Age <br /> <br />REPORTED BY <br />5 County Health Departmonl <br />q DNl!JConIefYation Olliœr <br />7 Slate. or I.oc:al Police <br />8 Privato CitIzen <br /> <br /> <br />INVESTIGATION PERFORMED BY <br />, IDEM Emerg.Resp.Sec. 5 U.S. EPA <br />2 Other IDEM Personnel 6 Other I ....J <br />3 DNRlConservallon Offiœc 7 IDEM ERS Field RlIsp. <br />4 County Haalth Department <br /> <br /> <br />own.-, <br /> <br />loçiden\ NumDe.r <br /> <br /> <br /> <br />CII <br />/1"" 1ò'¿S v¡/(,,!.- <br />Counly <br /> <br />SARA ¡¡lie III YES <br />Reponable Quanll\y <br /> <br />Notificallon TIme <br />AM <br /> <br />f{; <br /> <br />.PM <br /> <br />¿ <br /> <br />.it ¿; 0 <br /> <br /> <br />ansportation- RaIlroad <br />ransportation. Truck <br />3 Transportation- Pipoline <br /> <br /><I T",nsportatio"... Barge <br />5 IndUSUiaI <br />6 Asria¡l1Ural <br /> <br />SOURCE <br />7 Commercial <br />8 Semi-Pubfic <br />9 Municipal <br /> <br /> <br />10 Unknown <br />11 Other! <br />12 Individual <br /> <br />acation (Address or DirectIOns!· <br /> <br />7671 <br />""...f. <br /> <br />Post-"· Fa~ Note <br /> <br />To CiQ.,<'.$ D <br />Co./Dopt. <br /> <br />SPILL LOCATION IN <br /> <br />,ea Arrected <br /> <br />d' U- <br />Site I /vea DB$a1pUon <br /> <br /> <br />~aler Affected <br /> <br />No Wale, Name <br /> <br />F01-Þ¿;;'f1! f'ss-3'i8'o <br /> <br />Phone' <br /> <br />MATERIALINFd <br /> <br />1 Pelroleum Product <br /> <br />2 AddIBue <br />~.tenal Hamll(s) <br /> <br />3 Mise Chemical <br />4 Mise Material <br /> <br /> <br />^at.t,al HamelS) <br /> <br />)1her Infcrma\lon <br /> <br />5 <br />6 <br /> <br /> <br />"'""~ <br /> <br /> <br />7 Other <br /> <br />8 Unknown <br />Quantity <br /> <br />Units <br /> <br /> <br />QU8nUlV <br /> <br />Units <br /> <br />¡ , EQuIpment Failure <br /> <br />CIRCUMSTANCES <br />5 Intennon¡¡1 OischarfJe <br />6 Miscellaneous <br />07 UnknQwn <br /> <br />T(anSpOnallon Ac.cjdent <br />"--' Œ:mptoycc EHQf <br />1'\ vanOùhsm <br /> <br /> <br />ENVIRONMENTAL CONSeQUENCES <br />11 Water Quality Violation 5 Undeterrmneo <br />Z No ,Waler OualllY violation n 6 Air Release <br />~ <br />3 r:ish Kill --.J 7 MinImal - lOG ONLY <br />1.4 Fis!) Kill &. Waler QUòlltV Vtolalron <br />