ERNS INCIDENT NOTIFICATION REPORT

Report: |~| CR Number:.

State:

| SpiB Time (HH/MM):

Material Type: (CiwckOn*) jj UnknownMaterial Name CHRIS CASNo. UN DOT No. Quantity Units (On*, On.) Quantity In Water

H> OH dm in*g* ten othID tbl ana unkgtl ton tth

I Source of Spifl: (Ch«*Any) l~| Hiohwav |~1 Railway Fl Pipeline I""] UST f"] Fixed Facili F1 OtherLJ Vessel LJ Offshore ED AST OlJnknownL_J Air Transport

I Vehicle 10 or Carrier No.:

I Source Description:

Reported Cause: (Ct»ckAn»)

None n LandAir [3-Walir BGroundwater

Within FacilityOther

H Transportation Accident FJ Operational ErrorEquipment Failure LJ Natural Phenomenon

Dumping Pi OtherUnknown

|~| None [No. of Deaths: None j Property Damage>$50,000:

cnenj-CDCD

cr:

fltt UUDU

REGION 3 INCIDENT NOTIFICATION REPORT Regional Case Number:.REGION-SPECIFIC

FOLLOW-UP

R source

AND£VAiUATJON

Incident Status Code:(Check One)

|~1 Classic Incident | | Critical Incident | | Non-Critical IncidentNo Furfter Action Remedial Action Field Simulation

\

Emergency Response Activity Date:Emergency Response Activity Within 24 Hours: I"""!

n-Cri8cdD«t«FofD«t«Qu«l»y FOLLOW-UP INFORMATION f lR I00502 Form Mtn'an 08/91

ERNS INCroENT IFICATION REPORT

Dacovery Date spiB Data (imy«v»):

QO* QHazStfeCHRIS CASNo. UN DOT NO Units{CM«OA^ Quanta In Water

rn Highway P] Railway [H Pipeline C]LJ AirTransport LJ Vessel OOffshore LJ

source DeeenptioRGroundwaterWKhtnFadttty

Medium Affected: (OwekAny)

Waterway Affadad: r^> ^> •v^p r/**^!,*/c-<£ {*^-*<s["1 Transportaion Acddent [ Operational ErrorLJ Equipment Failure O Natural Phenomenon

Dumping Q OtherUnknown

Reported Cause:

None I Property Damage>$501000:

Ratponsa Actions Taken-

I. DAMAGE

ill

ARI 00503RD i

ERNS INCIDENT NOTIFICATION REPORT Aaolorul CM* tfc

JMPjjiijJi ^^

NRC Cue Number:A H f f ' O R T F R gpjjiM^ ;iiiiiii• it111i|ii,i.iii.Mii.-|i• '.yriifri.-i.i.i.M.iM-iii.i.iijfftfe riiYiir'llll-"--i-'-i-'-------:'i?M^J<^'''*^>:':'>:vMg*^*^^' ' ' - • ' ' r - - - - - - • • • • • • ' ' - -Jt.-K-: vi-Svwa-' •••- • ;-;'.->:«:;'. •• •iv'.-aSf.- :•:•;•:-:• ii- :•:•:•:••.•'.•:>• ™- oiM^wt-Lv..:-;-;-1.;.-. •.-..•,•.-.-•.• .-.-.U. I1.1.- .•.•.-.- .-.-.<• W?raT?1ST' ' '' iffT!!1! SS!f**'*"'W*** ^ •• ••

lSiiiiJiiiiSi ^

OuhwgtrName Phom:< •xt:'PliJu'LJi'i'' '''''''-"l'''''t'"'~n''''''''''"J:"'L'":H "."'"J !:!:''! ! llJ4; LVl' '*!''''.':''"'':';.?Slfl :J::s :f s:5: ^

Ctty:

C. INClOf NTLOCATION

SMator Approx Locatfoi:

D. DA If

E MATEF1IAL

Discovery Date Spill Date nmwttyy):Malarial Typt: fH UnknownItoteriafNfttne CHRIS

QHazSub{Spa Time H*M*ftt ^5^

CASNo. UN DOT No. Ouantty Onto (CM. On^ Qunl ln Water

F SOURCE SouroBOfSpfl: (CM*** Q H0hway Q RaUway Qmptfna Q IJSTLJ AfrTrwport Q VMM! LJOfWwe LJAST

***tyUtMuwwn O'

VMetolO«rCarrtwNo. ^^o r.uniuM ItedJum AOsctod: Now

AirUndWater

OttwUnknown

RflporM Cwse: nartsponaoon AoEquipment Failurt dOparadonai Eiror j Dumping rjOtw

Natural *tMnmnon ^ 3 Unknown

I. DAMAGE: Mont ftap«vDamagoi4SOJOO:J, ACTIONS

v^^y<J

K. NOTIFIED

L. COMMENTS

^ ^ jgllliil ^ M iiiPliiliiyM RESPONSE

AMDEVALUATION

ARion.snL

ERNS INCIDENT NOTIFICATION REPORT Regional Case Number;

Muttpte Regional Casa Number.

/ORTERwacy Act

NRC Case Number: VPfc* SSI Report CR Number:

C. INCIDENTLOCATION

li ^ iji ^ j.j'.a^ ^ ^&^ ii8tr»et or Approx. Location:

Zip:D. DATE

E. MATERIAL

Oftcovary Data SpiB Date (rnnWyy):

Material Type: p^OnknownCHRIS GAS No. UN DOT No. Quantity UnBs(CM»OMU Quanttyti Water

Source o*Sp«:J Air transport

Reported Cane

I. DAMAGE

J. ACTIONS

No.oftnjuriee: None Ifto. of Death*: E^None | Property Damage>yso.OOO:

R«pon« Actonj Taken:

ERNS INCIDENT NOTIFICATION REPORTMultipie Report: }—| RagionalTlma (Hmtttp:Reported

Recorded MuiSpte Regional Case Number:SSI Report: |—|NRC Case Number:

A. REPORTER•Privacy Act

Discharger Name:

Discovery Date (mmrt&nf. Spill Date (mrrrtd/yy): Spin Time (HH/MM):

Material Type: (d»ek on.) fl UnknownCHRIS CASNo: ' UN DOT No. Quantity Units (Ckd«(>yi Quantity In Water

MM trniu*.g*l lea »*-——

F. SOURCE | Source of Spill: <ch«* Any) PI HighwayCD Air Transport

Railway I I Pipeline j"~] UST {""Lffxed Facility l~lVessel D Offshore LJ AST 1^1 Unknown

Other

Vehicle ID or Carrier No.:(Source Description:

Medium Affected: B B GroundwaterWithin Facility

rnptherv! Unknown

Reported Cause: __ Transportatkxi Accident j_JX)pera8ona££rror_ Equipment Failure II Natural Phenomenon

__ Dumping [_J Other_ Unknown

(Cause Description:I. DAMAGE

J. ACTIONS

No. of Injuries: |~] None JNaofDeaths: |—| None Property Dama9e>$SO,000: [—|

K. NOTIFIED

"L. COMMENTS

M. RESPONSEANDEVALUATION

A R I 0 0 5 0 6

ERNS INCIDENT. NOTIFICATION REPORT Regional Case NurrcerMultiple ReportMultiple Regional Case Number:

Report: fH

ContkteflBaSiy Requested: | j

Organization Name;

[ JStata Q Local QlFederafOrganization: iC-K«.c<-st

Private Co. Q Public Q State QLocal

Same As 8 f"]

Discovery Date (

| | Haz Sub [ | OtherMaterial Type: (Check on«>UN DOT No. Quanoty Units .'Circ^On*) Quantity in Water

Source Of Spill: (Chock Any) Pipeline I ]Offehore LJ

Rxed Facility I ]

Tank Units: (Q.I.OMSource Description:

GroundwaterWithin Facility

Waterway Affected:

Reported Cause: Transportation AccidentEquipment Failure

Operational ErrorNatural Phenomenon ^ ^ =Unknown

None Property Oamage>S50.000: j—[

Evacuation: f"t Response Actions Taken: ^

Caflef Hai: Notified:

;; QjOttw Q Unknown•• *y-;X-/-i. • •£••'•' ''^'''Jf-^f,' '•'•••'••••. .-:•' %^j--C ;?i?er<**:-;:;v-Q Discharger f~|: FadBtat EPX •/' Fl Other Q Unknown

Oteehargef f~ji Fedetiai : Fl OtHef Fl Unknown

ERNS ENCIDENT NOTIFICATION REPORT Regional Case Number- D> \/ ^

Reported Time JHH-UU): )*•( *~ Multiple Report: Regional Time (HH/uu>:

Recorded By: Muftfple Regional Case Number:

Through NRC:A. REPORTER

•Privacy Act

NRC Case Number: ) I °\ SSI Report: FJ

Confidenttai r Requested: FJ 'Reported B y r ~ T ^

CR Number-

^^^^SI yf%^ j

Organizatran: (»»ct<.o<n> || Discharger | [Pufalie: { [Stale FJ Local gjfederat { {Unknown

'Address: 'Phone:

cay:B. DISCHARGER

Discfiarger Name:

Same As A

County: State-

Otganizafon: (CIT«*CM [V Pfivata-Co. FJPublle FJState FJlocai FjFederal QUnknown

Phone: ( extContact Name: 2nd Phone: exL:Address:

City:

C. INCIDENTLOCATION

I Same As A { \Same As B \ \

County: State: Zip:

Street or Appro*. Location:

JGity:D. DATE

E. MATERIAL

LU .JL

County:I Discovery Date

Zip:Spill Datetrmydd/yy). QJ fa j iQl "T

Mlepost:Spill Time (HWMM):

Material Type: (Check On«) | | Unknown | |Oil Haz Sub | I Other

Units (C,rd« On.) Quantity In Water

B HighwayAil

Railway Fl Pipeline Fl USJ*-T2 Jt5fed Facility I I OtherL^HSST L_ Un

Vehicle ID or Carrier No.: Number of Tankssource Description:

GroundwaterMedium Affected: ___ Within Facility

Waterway Affected:

Reported Causa: (Ch**Any) Operational Error Dumping |—[Other? Equipment Failure Natural Phenomenon

Cause Description: /\\ E354—^2None Property Damage>$50,000: r~]

Evacuation: { | Response Actions Take

| | QischaroiarAgefK^NjOTffc;;p;;;|;:|||p|;; g_j; tocat>; [

IO total PI' Slaie I I Otechargar Fl Fedwaf Fl If?* • Fl Qthef fl Unknown

A R I 0 0 5 0 8

INCIDENT NOTIFICATION REPORT Regional Case NumberMultiple Report:Time (HHMUI-. \Multiple Regional Case Number:

NRC Case Number: t S 1Through NRC:: ; j

Jj zatertSifC^^

B. DISCHARGED

Discharger Name:9 fe ||||j

Phone: ( ext:

City:

C. INCIDENTLOCATION

D. DATE

E. MATERIAL

Same As ASame As B {XX

County: State: Zip:

Street or Approx. Location:

County: State:

Discovery Date \ 2/5 j /Zip:

Spill Date (nvrVddiyy):

Milepost:

Spill Time (HH/MMJ: j /

Material Type: Unknown | Oil Q|HazSub Qj OtherMaterial Name CHRIS CAS No. UN DOT No. Quantity Units (Cird«0n«) Quantity In Water

M dm unitton olh

TB bU dm un*01; ten atft

Source of Spill: (Ch»ek Any) PI Highway JHJ Railway [H) Pipeline fZJ UST JSJ Fixed Facility I—I OtherI ILJAir Transport LJ Vessel LJ Offshore LJ AST Unknown

PILJ

Vehicle ID or Carrier No.: j Number of Tanks: | Tank Capacity: Tank Units: (Ctd. on.)

Medium Affected:

Waterway Affecte

None r_ LandAir IS Iwater

GroundwaterWithin Facility B other

Unknown

VIH.CAUSE

I Cause Description:

I Reported Cause: Transportation Accident PJ Operational ErrorEquipment Failure LJ Natural Phenomenon

Dumping Q OtherUnknown

|—| None No. of Deaths: None

Response Actions Taken: 4

Property Damage>$50,000: ["""|

^ :|||t|§||||ij!|||

1_ COMMENTS

A R I 0 0 5 0 9