Spill Report
ASE Safety Management System
Date of Spill
-
Month
-
Day
Year
Date
Time of Spill
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Report
First Notification of Spill
In Progress
Final Report
DRILL DRILL DRILL
Operating Department
Admin Services
Construction
Source Water
Drilling
Completions
Production
Maintenance
Wellservice/Workover
Lease/Location Name
RRC Lease Number
Foreman Name
First Name
Last Name
Person Reporting (save when done)
Person Reporting Email
example@example.com
Type of Spill
Non-Recordable
Recordable
Information Only
Material Spilled
Rows
Bbls Spilled, or
Gallons Spilled
Amount Recovered
Oil
Diesel
Condensate
Chemical
Water
Lubricating Oil
OB Mud
Other
Other Product Spilled
Company/s Involved (save when done)
People Involved (save when done)
County
Atascosa
Other
Waterways Impacted
Rows
Yes
No
Waterway/s nearby?
Did spill enter waterway?
Drainage route impacted
Name of Waterway/s (save when done)
Spill Details/Cause of Spill (provide as much detail as possible)
How Was Spill Contained (provide as much detail as possible)
Clean up action taken
Additional Remarks:
Type of Ground
Lease
Dry Land
Pasture
Irrigated
Farm Land
ROW Access
Containment
Road/Highway
Farmland or Crops Impacted
Yes
No
Type of Farmland/Crops Impacted (save when done)
Landowner Informed
Yes
No
Landowner Identity (save when done)
Estimated Cost of Cleanup
Notifications Made (use "X"):
Rows
Yes
No
State Oil & Gas Commission informed
NRC Informed
EPA Informed
RRC Informed
Third Party (A&D Environmental)
RRC Ticket Number
Did any regulatory official visit spill site (save when done)
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Order of Events
Investigation
Investigation Team
What Happened
Causal Factor(s)
Root Cause(s)
Corrective Action Item(s)
Clean-Up Completion Date
-
Month
-
Day
Year
Date
Report Closed By
First Name
Last Name
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Should be Empty: