Notification of Fire, Spill, Leak, or Blow Out 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Permit Number if applicable. Specify the type of incident: Fire, Spill, Leak, or Blow Out.
3. Fill in the operator's name and date. Provide the address details including city, state, and zip code.
4. Complete the facility name and location fields. Include county information along with latitude and longitude coordinates.
5. Indicate the field status. If it's a wildcat field, make sure to state that clearly.
6. In the notification section, document who was notified from OGB staff along with reporting date and time.
7. Detail when the incident occurred by filling in both date and time. Indicate if there were any injuries or fatalities.
8. Describe the material spilled and provide an estimated volume. Confirm whether it was contained on location.
9. If applicable, describe affected areas and any agencies notified regarding water contamination.
10. Outline circumstances causing the incident and measures taken for control and cleanup efforts.
11. Finally, ensure you sign as the operator’s agent certifying that all information is accurate before submitting your report.

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