Reason for Spill: Insert Reason for Spill/Leak Discharge to Waters of U.S.: Insert Whether Spill/Leak discharged to a Water of the U.S. Date: Insert Date Condition was Identified Immediate Actions: Insert Description of Immediate Actions Taken Actions within 14 Days: Insert Description of Actions Taken within 14 days of discovery 14 Day Infeasibility: If Applicable, document why it is infeasible to complete necessary installations or repairs within 14-day timeframe and describe schedule If Applicable, document rationale sent to EPA for extension of 45 day 45 Day Extension: timeframe Description of Condition: Insert description of condition trigering the need for corrective action For Spills and Leaks: Description of Incident: Insert Description Material: Insert description of material Date/Time: Insert Date/Time Amount: Insert Estimated Amount of Spill/Leak Location: Insert Location of Reason for Spill: Insert Reason for Spill/Leak Discharge to Waters of U.S.: Insert Whether Spill/Leak discharged to a Water of the U.S. Date: Insert Date Condition was Identified Immediate Actions: Insert Description of Immediate Actions Taken Actions Taken within 14 Days: Insert Description of Actions Taken within 14 days of discovery 14 Day Infeasibility: If Applicable, document why it is infeasible to complete necessary installations or repairs within 14-day timeframe and describe schedule 45 Day Extension: If Applicable, document rationale sent to EPA for extension of 45 day timeframe H. Benchmark Exceedances Insert Date Date: Pollutant Exceeded and Results: Insert Pollutant Name Quarter 1 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 2 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 3 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 4 (Sample date: Insert Sample Date) Result: Insert Sample Result Average Result: Insert Value Benchmark Value: Insert Benchmark Value from 2015 MSGP
Reason for Spill: Insert Reason for Spill/Leak Discharge to Waters of U.S.: Insert Whether Spill/Leak discharged to a Water of the U.S. Date: Insert Date Condition was Identified Immediate Actions: Insert Description of Immediate Actions Taken Actions within 14 Days: Insert Description of Actions Taken within 14 days of discovery 14 Day Infeasibility: If Applicable, document why it is infeasible to complete necessary installations or repairs within 14-day timeframe and describe schedule 45 Day Extension: If Applicable, document rationale sent to EPA for extension of 45 day timeframe Description of Condition: Insert description of condition trigering the need for corrective action For Spills and Leaks: Description of Incident: Insert Description Material: Insert description of material Date/Time: Insert Date/Time Amount: Insert Estimated Amount of Spill/Leak Location: Insert Location of Reason for Spill: Insert Reason for Spill/Leak Discharge to Waters of U.S.: Insert Whether Spill/Leak discharged to a Water of the U.S. Date: Insert Date Condition was Identified Immediate Actions: Insert Description of Immediate Actions Taken Actions Taken within 14 Days: Insert Description of Actions Taken within 14 days of discovery 14 Day Infeasibility: If Applicable, document why it is infeasible to complete necessary installations or repairs within 14-day timeframe and describe schedule 45 Day Extension: If Applicable, document rationale sent to EPA for extension of 45 day timeframe H. Benchmark Exceedances Date: Insert Date Pollutant Exceeded and Results: Insert Pollutant Name Quarter 1 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 2 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 3 (Sample date: Insert Sample Date) Result: Insert Sample Result Quarter 4 (Sample date: Insert Sample Date) Result: Insert Sample Result Average Result: Insert Value Benchmark Value: Insert Benchmark Value from 2015 MSGP
msgp2015_recordkeepingtemplate.docx