Petroleum Spill Form
** Pease submit this form to the Dept. of Environmental Health & Safety within 1 business day of incident**
Incident Date:
Incident Time:
Date Reported:
Location:
Type of Material Spilled (i.e. waste oil, gasoline, diesel, kitchen grease):
Approximate Amount of Spilled Material (Gallons):
Estimated Property Damage and Cost of Cleanup:
Disposal of Contaminated Materials:
For Questions Please Call Environmental Health & Safety at 315-267-2596 or 315-267-2747
For EHS Use Only
Contact Outside Agencies:
Yes
No
Fire
Yes
No
US EPA
Yes
No
Other:
Hazmat
Yes
No
National Response Ctr
Yes
No
NYS DEC
Yes
No
Media Interest
Yes
No
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