SPILL-SPECIFIC INFORMATION REQUIREMENTS

The Spill Response Questionnaire presented in this Section represents the information needed by DBRC to effectively mobilize equipment and resources for a spill response in a timely manner.

In order to activate DBRC, this form should be filled out as completely as possible.
The form represents an agreement between DBRC and the spiller to deploy DBRC equipment and expend resources on the spiller's behalf.


DBRC will respond to oil spills only. Oil means oil of any kind or in any form, including, but not limited to, petroleum, fuel oil, sludge, oil refuse, and oil mixed with wastes other than dredged spoil, but does not include petroleum, including crude oil or any fraction thereof, which is specifically listed or designated as a hazardous substance under subparagraphs (A) through (F) Act (42 U.S.C. 9601) and which is subject to the provisions of that Act.

It is the responsibility of the spiller to prepare a site safety plan and to inform DBRC of any specific safety hazards associated with the spilled oil.


SPILL RESPONSE QUESTIONNAIRE
DBRC Authorization Information
1.
Date (mm/dd/yy):
/ /
2.
Time (24 hr.):
3.
Member Company or Subscriber Name:
4.
Name of Authorized Representative Making Request:
5.
Representative's Phone Number:
/ /
6.
Representative's FAX Number:
/ /
7.
Name of Person in Charge of Spill Response:
8.
CALL BACK PHONE NUMBER:
/ /
9.
Facility/Vessel Involved:
Incident Information
10.
Time of Spill ( 24 Hr.):
11.
Location of Spill (Latitude/Longitude):
/
12.
Location Description:
13.
Size of Spill(circle one):
Small(50 bbls or less) Medium (50 – 1000bbls) Large (>1000bbls)
14.
Product Spilled:
15.
Unusual Safety Considerations?:
16.
Printed Name:
After submitting this form, call to confirm submission.
CONFIRM BY CALLING 302-645-7861
Enter the correct value below.
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