Action Center / Spill or Illegal Discharge Report / Davenport, Iowa

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Spill or Illegal Discharge Report

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City of Davenport Staff Use Only.

Use this form to document an emergency spill and/or illegal discharge.

An emergency spill is defined as the release, spill, or overflow of any hazardous substance on a surface, reaching, or potentially reaching a creek, stream, or storm intake in the City of Davenport.

An illegal discharge is any non-stormwater discharge (not necessarily a hazardous substance) to the storm drain system.

The purpose of this form is to collect the data necessary to report hazardous substance spills and illegal discharges in the City of Davenport in accordance with reporting requirements of Iowa Code Chapter 131 and the City’s Iowa DNR NPDES permit 82-22-0-05.

* Denotes a required field

Task #*

Date and Time Received*

MonthDay Year, HourMinute : AM/PM

Date and Time of the Onset of the Condition, if known. If unknown, enter 01/01/24 at 01:05.*

MonthDay Year, HourMinute : AM/PM

Date and Time the Condition was Discovered. If same as the onset, enter 01/01/24 at 01:05.*

MonthDay Year, HourMinute : AM/PM

Address or Location of Spill or Illegal Discharge*

Select the type of spill or discharge*

Spill on surface, contained

Spill on surface, potential to discharge to storm sewer system

Spill on surface, actively discharged to storm sewer system or surface water

Illegal Discharge to Storm Sewer System

Illegal Discharge to surface water

Characteristics of Spill or Discharge: Color*

Characteristics of Spill or Discharge: Odor*

Characteristics of Spill or Discharge: Sheen*

Characteristics of Spill or Discharge: Suds*

Characteristics of Spill or Discharge: Other*

Name of Material or Materials Spilled or Discharged*

Material Manufacturer's Name, if known.*

Volume of material released, if known. If more than one material, provide volume of each material. Indicate whether quantities are known or estimated in response.*

Is the material or materials hazardous?*

Where did the material/substance go?*

Name the surface water it drains into, or the surface water directly discharged to, or describe other.*

Weather at the time the spill or discharge was identified. Wind, Temp, Precipitation.*

Name, address, and telephone number of the party responsible for the condition.*

Name and telephone number of the person closest to the scene of the condition who can be contacted for further information or action.*

Is there any other pertinent information (such as circumstances leading to the condition, visible effects) that may assist in the proper evaluation of the incident by the Iowa DNR?*

Describe Containment Measures Taken*

If a sanitary sewer connection is suspected, describe the location of the nearest sanitary sewer manhole or segment and its Asset ID, if known.*

DNR Notification. Within 6 hours of onset or detection of a hazardous substance release notify the Iowa DNR regional wastewater staff by telephone at 515.725.8694. The Emergency Spill Report must be submitted to the IDNR within 30 days of the occurrence.

Was this a hazardous material incident?*

Please Do Not Complete The Following Field

Name of IDNR Representative the incident has been reported to. Enter N/A if not a hazardous material incident.*

Date and time hazardous material incident reported to the IDNR rep. If not a hazardous material incident, enter 01/01/24 at 01:05.*

MonthDay Year, HourMinute : AM/PM

IDNR Spill Number provided by the IDNR Representative. If not a hazardous material incident, enter N/A.*

Spill or Illegal Discharge Report

Spill or Illegal Discharge Report

DNR Notification. Within 6 hours of onset or detection of a hazardous substance release notify the Iowa DNR regional wastewater staff by telephone at 515.725.8694. The Emergency Spill Report must be submitted to the IDNR within 30 days of the occurrence.

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