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<br />A. Hazards: Indicate if any of the following are present or pose a hazard at this incident by checking <br />appropriate boxes: <br />o Overhead lines 0 Buried utilities 0 Radiation devices <br />o Excessive noise 0 Temperature Extremes 0 Flammable/Ignitable <br />o Unusual water level or currents 0 Extreme weather conditions <br />Comments: <br />B. Hazardous Materials (Known or Suspected): The following are the products that <br />could be expected to be in the vicinity of the incident. (Obtain copies of MSDS) <br />Material MSDS Number Quantity <br /> <br />C. Toxicological Hazards: Inhalation:D <br />Substance: PELlTL V: <br />Substance: PELlTL V: <br />Substance: PELlTL V: <br />D. Weather: (See weather data log) <br />E. Future weather conditions that may affect Incident site: <br />F. Prevailing Wind Direction: <br />VI. JOB ACTIVITIES IN WORK PLAN (Check all activities, which apply for this event). <br />A. Steps taken to protect the public (Site Control): <br />DEvacuations, DBarricade, 0 Site Assessment: <br />B. Steps taken to stop discharge (Containment): <br />o Pump shut down 0 Line section blocked in 0 Line clamp installed <br /> <br />Ingestion:D <br />IDLH: <br />IDLH: <br />IDLH: <br /> <br />Skin:D <br /> <br />C. Steps taken to limit movement of material (Confinement): <br />Boom Deployment for: 0 Containment 0 Diversion 0 Exclusion <br />Dam Construction Type: 0 Dike 0 Underflow 0 Retention <br /> <br />D. Steps taken to repair facility: <br />Excavation: 0 Hand 0 Trenching 0 Bell-hole <br />Line Repair: 0 Line Breaking/Cutting 0 Drain-up 0 Cold-Tapping <br />DWelding 0 Grinding 0 Hot Tapping 0 CuttinglBurning <br />o Cold Cutting 0 Other: <br /> <br />E. Steps taken to recover discharged materials: <br />Recovery location: 0 Land 0 Near shore 0 Water/Stream DRiver OLake <br />Methods/equipment: 0 Skimmers 0 Vac. Trucks DBoat Work DAbsorbents <br /> <br />F. Steps taken for re-mediation/clean-up: <br />Sampling: 0 Soil 0 Water 0 Drums 0 Roll-off 0 Private wells <br />Waste Management: Types: 0 Liquid D Solid D Sludge 0 GasNapors <br />Placed into: 0 Drums DRoll-off D Stock pile D Trucks <br />D Other: <br />G. Miscellaneous: DLine marking OSurveying OWildlife Hazing <br />DPhotosNideos <br />H. Other (specify): <br /> <br />29 <br />