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Use to send timely information on status of oil, hazardous material, or hazardous waste spill that could have immediate environmental and/or health effects. Sent IAW unit SOPs and commander’s direction. NOTE: Spill reporting and reportable quantities are mandated by federal law.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — DATE/TIME __________________________________(DTG of Spill Discovery)

LINE 4 — MATERIAL___________________________________(Material Spilled)

LINE 5 — QUANTITY___________________________________(Quantity of Spilled Material)

LINE 6 — LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator) of Spill)

LINE 7 — CAUSE ______________________________________(Cause and Supervising Unit)

LINE 8 — SIZE ________________________________________(Size of Affected Area)

LINE 9 — DAMAGE____________________________________(Damage to the Natural Environment (if required))

LINE 10 — HAZARDS___________________________________(Hazards to Friendly Forces and/or Civilian Personnel)

LINE 11– ACTIONS_____________________________________(Summary of Actions Taken)

LINE 12 — UNIT POC___________________________________(Supervising Unit POC)

LINE 13 — ASSISTANCE________________________________(Assistance Required/ Requested)

LINE 14 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 15 — AUTHENTICATION___________________________(Report Authentication)

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