VILLA RIDGE AREA EMERGENCY RESPONSE ACTION PLAN
PHMSA Sequence Number XXX Owner/Operator:
Phillips 66 3010 Briarpark Drive Houston, Texas 77024
24-Hour Number: (800) 231-2551 or (877) 267-2290
Page A7-1 Confidentiality Notice: This document is for the sole use of the intended recipient(s) and contains information that is considered to be proprietary to Phillips 66. Any unauthorized review, use, disclosure or distribution is strictly prohibited.
Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
Appendix 7: ERAP Table of Contents 7.1
Area Information ........................................................................................................1 7.1.1
Villa Ridge Area Pipeline System ...................................................................1
7.2
Communication Equipment ........................................................................................2
7.3
Notification Sequence ................................................................................................2
7.4
Emergency Notification Contact List ..........................................................................5
7.5
Emergency Response Equipment, Testing & Deployment .........................................8
7.6
Immediate Actions .....................................................................................................9
7.7
Maps and Diagrams.................................................................................................11
7.8
Response Forms .....................................................................................................13 Incident Report Form ...............................................................................................14 ICS 201-1 - Incident Briefing Map/Sketch ................................................................17 ICS 201-2 - Summary of Current Actions .................................................................18 ICS 201-3 - Current Organization ............................................................................19 ICS 201-4 – Resource Summary .............................................................................20 ICS 201-5 - Site Safety and Control Analysis ...........................................................21 Weather Report .......................................................................................................22 ICS 202 – Incident Objectives ..................................................................................23 ICS 203 – Organization Assignment List ..................................................................26 ICS 211 - Check-In List ............................................................................................27 Spill Trajectory Form................................................................................................28
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Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
The purpose of this Emergency Response Action Plan (ERAP) is to provide quick access to key types of information that are often required in the initial stage of a spill response. The information provided in this ERAP is presented in greater detail in other sections of the plan.
7.1
Area Information 7.1.1
Villa Ridge Area Pipeline System
Response Zone Location Line Sections Counties Mile Posts WCD Telephone (day/night) Address Owner Owner Location (street) Emergency Telephone City County Qualified Individual
Alternate QI
Area Information Rosebud Pump Station to the East St. Louis Terminal Gold Line (10”/12”) from MP 602.52 to MP 681.25 (Product) Blue Line (8”/10”) from MP 602.52 to MP 681.25 (LPG) Gasconade, Franklin, Jefferson and St. Louis, Missouri 602.52 to 681.25 Rosebud to Villa Ridge line: 1,127,070 gal.(26,835 bbls) 940-631-0272 (both) 2116 Idlewood Road, Jefferson City, MO 65109 Phillips 66 3010 Briarpark Drive 800-231-2551 or 877-267-2290 Houston State Texas Zip 77042 Harris Telephone 281-293-6600 Derick Gipson – Area Supervisor 573-636-4425 – Office 940-631-0272 – Mobile David Kee- Maintenance Leadman 636-742-0263 – Office 314-960-2122 - Mobile
Pipeline Description The Villa Ridge Maintenance Group has maintenance responsibilities for the pipeline corridor between the Rosebud Pump Station and the East St. Louis Product Terminal. The pipeline in this zone is 8”, 10", and 12" in diameter and 79 miles long. The line is also located near an environmentally sensitive area (Mississippi River).
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Villa Ridge Area Response Zone Appendix
7.2
Appendix 7: ERAP
Communication Equipment Primary communications for Company response activities will consist of the following: Company mobile phones, hard line phones, faxes, and Company intranet devices, VHF-FM marine radios, VHF-AM aircraft radios, UHF oil spill radios, HF Single • Sideband radios, satellite phones and paging systems. Company Response Team mobile and office telephone numbers are located in • Annex 2 of this Plan. Communications needs beyond primary communications devices will be supplied • by Company contracted OSRO's. OSRO telephone numbers are located in Annex 2 of this Plan. •
7.3
Notification Sequence Facility, Corporate & Regulatory Notifications In the event of an emergency, it is the responsibility of the Incident Commander (IC) to ensure that the required and applicable notifications are made. However, if the Incident Commander elects to do so, he may choose to delegate these notifications to the appropriate support resources. (Refer to Emergency Notification - Telephone List, located in this plan for support resource contact information.) NOTE: Use the Incident Report Form, Notification Information to document notifications completed and follow-up requests.
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Midstream Operations Notifications Flowchart 3rd Party Reports an Incident
Call 9-1-1, Fire, Injury, Police?
as needed. Yes
Local Supervisor, Division Manager Or Project Management
No
Need to shut pipeline Down?
Yes
Control Center
Control Center Console
No
Emergency Response
Duty Officer
*Project Management notifies
Security Environmental
All Call into the Meet-Me Line for Initial Notification Briefing, as invited.
Local Supervisor if working at an exsiting asset.
Review Midstream Operations Incident Reporting Guidance Document
Health & Safety
D.O.T. Managers
Notifications, as appropriate: No; IST Briefing, as needed.
Agency Notification?
EMERGENCY TELEPHONE NUMBERS: Duty Officer 24/7 …………………………..……(800) 231-2551 – Fax: 918-977-6119 Control Center ………..……….….…. (877) 267-2290 Meet Me Conference Line .….…..(888) 337-0215; Code: 7554123# Axiom Medical Consulting ……………….……. (281) 419-7063 Employee Hotline (Evacuation & Natural Disaster)….. (866) 397-3822 Crisis Management Hotline ……………………..(855) 699-8701 or (832) 765-3500
Crisis Management Notification by Manager?
Yes
No
1. Agencies, as needed. 2. Incident Support Team 3. Crisis Management Hotline, as needed.
Yes
Revision: 20160308
*Updates in Green
Incident Reporting Guidance Document Midstream Operations Incident Notification & Reporting Tool Rev. Date-Sept. 1, 2015 All of the following incidents should be reported to the applicable MLT member as soon as possible. Incidents should also be reported to the Duty Officer (DO) as indicated on the table below. The blue shaded OLT column notifications should be completed by the applicable TLT member. Midstream Operations HSE is responsible for reporting incidents to the Crisis Management (CM) Hotline. Duty Officer Number: 1-800-231-2551 Crisis Management Hotline: 1-855-699-8701
Incidents requiring applicable OLT member notification INJURY: Incident resulting in an on-the-job employee, contractor or public fatality, multiple injuries/illnesses, or serious individual injury/illness requiring immediate hospitalization for observation, transport via ambulance to a hospital or trauma center and/or medical treatment. Any recordable injury; any injury or incident that has reasonable potential to result in harm to the injured party or become a recordable injury; or any injury requiring clinic visitation requires a DO call and Support Team Discussion. Examples include loss of consciousness, inhalation of chemicals, exposure to toxics, head injury, heat stress, burn, impact & serious vehicle incident. Excluded from this requirement are minor first aids. Serious non work related illnesses which become symptomatic at work
DO
OLT/HSE to OLT CM
X
X
X
X
2 or More
X
Any serious motor vehicle accidents SPILLS/RELEASES: Any spill or release affecting residences or businesses (beyond nuisance odors)
X
X
X
X
Any product release greater than 5 gallons, or potential to exceed 5 gallons. This includes suspected, but not yet confirmed potential leaks.
X
Sudden and/or significant loss of pressure on a pipeline system (PLM Alarm), 3rd Party report of odor, visible product, vapor, release resulting in either a fire or explosion, sheen/stain on or near Phillips 66 asset of Right of Way. Any spill/release to environmentally sensitive areas, such as national parks or wildlife habitats and refuges, tribal land etc. to any water of the United States.
X
X
X
X
HVL (propane, ethane-propane) release greater than 5 gallons or potential to exceed 5 gallons.
X
X
Greater than 100 bbls to public land/property (not contained in a tank dike)
X
X
X
That causes closure, stoppage or re-routing of traffic on public road or waterway.
X
X
X
Any Notice of Violation or Notice of Potential Violation PROPERTY DAMAGE/BUSINESS INTERRUPTION Property damage events exceeding or likely to exceed $50,000 ($25,000 Washington) in estimated damages (example fire, pipeline repairs, cleanup, value of lost product, collision, act of nature, vandalism, theft, etc.)
X
If >1 BBL
X If >$500M gross
X
X
Business interruption (potential): systems down/not operating as normal EVACUATION/SHELTER IN PLACE Evacuation beyond facilities of employees or contractor personnel (includes evacuation as a result of storms or threat of storms).
X
X
X
X
X
Shelter-In-Place or mandatory evacuation of the public. PUBLIC RELATIONS/ACUTAL OR POTENTIAL COMPANY IMPACT Any situation that should be brought to the attention of corporate management due to the actual or potential impact on company such as:
X
X
X
X
X
X
Incident with media on-site at the incident location. Transportation incidents such as derailments or truck/trailer accidents, involving our products resulting in a closure of a public road and/or re-routing or stoppage of traffic.
X
X
X
X X
X X
X X
Complaints of acute illness by third parties allegedly caused by our operations or products (i.e. calls by more than one individual) SECURITY
X
X
X
Theft or Vandalism of Company property, equipment and/or facility
X
Security Breach (trespassing)
X
Suspicious activity (Picture taking, parking near facility, etc.)
X
Serious security incidents (i.e. acts of terrorism, bomb threats, sabotage, kidnapping, employee violence, etc.)
X
X
X
Threats by telephone or warnings from local enforcement. OTHER All Resignations/Terminations
X
Confrontations with anti-industry groups that could attract media attention.
Potential legal action
X X
* Includes Partner/ JV operated incidents. Non-operated JV incidents should be reported directly to the Duty Officer. Official Document Location: Livelink Retention: ADM 220/2Y Page 13 of 50
Villa Ridge Area Response Zone Appendix
7.4
Appendix 7: ERAP
Emergency Notification Contact List See Emergency Notification Contact List on the next page.
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Villa Ridge Pipeline Area Emergency Notification Contact List Emergency Response Numbers Group / Function Duty Officer Control Center Emergency Hotline Company "Meet Me" Number Employee Hotline (Natural Disaster) Axiom Medical Monitoring
Telephone (800) 231-2551 (877) 267-2290 (888) 337-0215 (866) 397-3822 (281) 419-7063
Other Telephone Fax: (918) 977-6119 (800) 231-2566 Access Code: 7554123#
Qualified Individual / Incident Commander (QI / IC) Contact List Name
Office Phone
Derick Gipson, Area (573) 636-4984 x13 Supervisor Office: 2116 Idlewood Rd. Jefferson City, MO 65109
Home Phone
Cell Phone
Resp. Time
(940) 631-0272
1 hr
Home:
Alt Qualified Individual / Incident Commander (Alt QI / IC) Contact List Name
Office Phone
David Kee, Maintenance (636) 742-0263 Leadman Office: 3285 Old Hwy 100 Villa Ridge, MO 63089
Home Phone
Cell Phone
Resp. Time
(636) 583-9481
(314) 960-2122
1 hr
Home:
Incident Support Team Position
Name
Office Phone
Alt. DOT Contact Manager, Engineering & Projects Manager, Logistics Director, Crisis Management Manager, HSE Manager, Division HSE Team Leader – Central/Amarillo
Todd Tullio Dave Barney Doug B. Sauer Steve Pepper Burt Bure Rodger Lewis Brad A. Hendrix
Home Phone
(832) 765-1636 (832) 765-1530 (918) 977-4080 (832) 765-1775 (832) 765-1362 (918) 977-4640 (918) 977-6231
(281) 746-7588 (918) 213-0481 (281) 812-0605
Mobile Phone (281) 685-3646 (281) 467-4732 (832) 274-8478 (281) 235-6176 (337) 356-1473 (806) 283-1277 (918) 977-0137
Midstream Operations Tier 1 Responders Name David Kee, Maintenance Leadman Darren Perkins, Senior Pipeliner
Office Phone
Home Phone
Mobile Phone
Resp. Time
(636) 742-0263 (636) 742-0263
(636) 583-9481
(314) 960-2122 (314) 541-7870
1 hr 1 hr
Emergency Response Contractors Name Contract
Phone
Alt. Phone
Resp. Time
Heritage Environmental Services, LLC MSRC & STAR Contractors Other
(800) 487-7455 (800) 645-7745
(800) 487-7455 (800) 259-6772
5 hrs
Brentco Air (Line Flyer)
(918) 625-0057
Agency / Other Telephone Numbers Agency / Group Federal
Telephone
Other Telephone
National Response Center EPA Region 07 U.S. Coast Guard Marine Safety Office U.S. DOT / PHMSA State
(800) 424-8802 (913) 281-0991 (314) 269-2463 (800) 424-8802
(202) 267-2675 (913) 551-7115
Dept. of Conservation - Missouri
(314) 751-4115
(202) 366-4595
Dept. of Natural Resources - Missouri MO Clean Water Commission MO State Fire Marshal Public Drinking Water, MO Office MO State Highway Patrol, Jefferson City Local
(574) 634-2436 (314) 751-5331 (573) 751-2930 (573) 751-5331 (573) 751-3313
Hospital, Barnes Hospital, St. John's Mercy Hospital, St. Anthony's Media: Radio FM-93.9 KSSZ Media: TV-8 KOMU LEPC: Gasconade County, MO LEPC: Jefferson County, MO LEPC: St. Louis County, MO Local Water Supply, Springfield Regional MDNR National Weather Service - Jefferson City Sheriff: Gasconade County Sheriff: Jefferson County, MO Gasconade County Ambulance Gasconade County Fire Department Gasconade County Highway Patrol Gasconade County Police Gasconade County Sheriff East St. Louis Emergency Management Agency Gasconade County Sheriffs Office East St. Louis Local Emergency Coordinator LEPC: St. Louis City LEPC, MO Police: St. Louis County, MO Sheriff: Franklin County East St Louis Fire Department East St Louis Police Depart
(314) 362-9123 (314) 239-8000 (314) 525-1000 (573) 875-1099 (573) 882-8888 (573) 694-68250 (636) 797-9999 (314) 628-5400 (417) 863-8028 (314) 441-8467 (573) 486-2424 (636) 797-5000 (573) 437-7770 573-646-3244 573-368-2345 573-486-2211 573-486-2424 (800) 782-7860 (573) 486-2424 (618) 277-3012 (314) 613-7232 (314) 615-4260 (636) 583-2567 (618) 482-6868 (618) 482-6767
(573) 265-2993 (636) 797-5381 (314) 713-4365
(573) 437-7770 573-646-3244 573-368-2345 573-486-2211 573-486-2424 (217) 782-7860 (573) 486-2424 Fax: (314) 622-3472 (636) 583-2560
Villa Ridge Area Response Zone Appendix
7.5
Appendix 7: ERAP
Emergency Response Equipment, Testing & Deployment This facility does not have spill response equipment. Emergency response contractors and their equipment will be utilized during a release, if necessary. See Appendix 3 for a list of OSRO/contractor emergency response equipment. Temporary Waste Storage Capabilities Contractor
Equipment
Capacity
Total Capacity
Heritage Environmental St. Louis, MO Heritage Environmental Indianapolis, IN
Portable storage Vacuum systems
1,245 bbls 142 bbls
1,387 bbls
Portable storage Vacuum systems
13,073 bbls 49,280 bbls
62,353 bbls
Total Storage Capacity
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Villa Ridge Area Response Zone Appendix
7.6
Appendix 7: ERAP
Immediate Actions Spill Response Checklist The following response activities represent suggested actions during a response to a spill. Person Taking Action (Initials)
Response Action
Date / Time Action Taken
First Person To Discover Spill 1. IMMEDIATELY NOTIFY TERMINAL SUPERVISOR OR ALTERNATE Primary Response Actions (Incident Commander or Designee) 2. ENSURE PERSONNEL SAFETY - Sound alarm, evacuate if necessary, account for all personnel, explain hazards, require appropriate PPE and secure spill area 3. ELIMINATE IGNITION SOURCES - Shut off motors, electrical pumps, electrical power, open flames, etc. in spill area 4. QUICKLY ASSESS SPILL AND SAFETY HAZARD – Spill size, rate, type, cause, movements, fire/explosion hazard and health risk 5. ACTIVATE PRIMARY RESPONSE TEAM – Utilize onsite personnel to extent possible and supplement with off-duty personnel 6. IF SAFE, CONTROL SPILL SOURCE – Shut down pumps, close valves, transfer oil from leaking tank, etc. 7. INITIATE FACILITY SPILL CONTROL – Block storm drains and close separator valves (if necessary), construct containment/diversion berms, apply sorbents, etc. 8. RE-ASSESS SPILL PARAMETERS AND RESPONSE – Estimate spill volume/rate, cause, type/classification, effectiveness of source/spill control operations, spill movements, safety/environmental concerns, weather/hydrographic conditions, etc. 9. INITIATE OFF-SITE SPILL CONTROL – For spill to river, initiate aquatic spill control and Sensitive Area Protection Notification/Documentation (Incident Commander) 10. NOTIFY APPROPRIATE COMPANY PERSONNEL - Primary Response Team Members, Qualified Individual, Company Management, Area Response Team Call Duty Officer 11. NOTIFY/ACTIVATE RESPONSE CONTRACTORS (As required) 12. NOTIFY APPROPRIATE REGULATORY AGENCIES – Federal NRC, State DEM, Regional Ecology office and others, such as LEPC, as necessary 13. NOTIFY THREATENED NEARBY PARTIES/SENSITIVE AREA MANAGERS (Uncontained Spills or vapor clouds only) 14. NOTIFY/ACTIVATE OTHER RESPONSE CONTRACTORS OR SUPPORT SERVICES (As required)
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Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
Person Taking Action (Initials)
Response Action
Date / Time Action Taken
15. INITIATE DOCUMENTATION PROCEDURES – Document all response actions taken previously and all subsequent response actions including notifications, agency/media meetings, equipment/personnel deployments, recovery and disposal of oil and oily waste, extent and degree of area impacted, etc. Secondary Response Actions (Primarily for Uncontained Spills) 16. ESTABLISH COMMAND POST/COMMUNICATIONS CENTER 17. INITIATE SPILL TRACKING AND SURVEILLANCE OPERATIONS – Helicopters, fixed-wing aircraft, vehicle (if safe) 18. IDENTIFY THREATENED SENSITIVE AREAS AND PRIORITIZE – Parks, wildlife/fish habitats, marinas, etc. 19. DEVELOP OVERALL RESPONSE OBJECTIVE AND INCIDENT ACTION PLAN – Maximize utilization of available equipment, personnel and logistics to limit the area affected by the spill and the associated impacts. Prioritize actions. Plan for the effective utilization of additional equipment and supplies as they arrive 20. IDENTIFY EQUIPMENT, PERSONNEL and LOGISTICAL SUPPORT REQUIREMENTS FOR SECONDARY SPILL RESPONSE OPERATIONS – Containment, protection, recovery and cleanup 21. IMPLEMENT APPROVED INCIDENT ACTION PLAN - In order of priority 22. ESTIMATE WASTE HANDLING AND INTERIM STORAGE REQUIREMENTS - Based on quantity spilled, recovery capacity, areas affected, degree of impact, etc. 23. ARRANGE FOR INTERIM SOLID AND LIQUID WASTE HANDLING AND STORAGE – Pumps, barges, portable tanks, available tankage at facility, debris boxes, lined storage cells, heavy equipment, permits, etc. 24. INITIATE LOGISTICAL SUPPORT FOR RESPONSE OPERATIONS – Transportation, lodging, meals, supplies, portable toilets, communications equipment, additional office space, etc. 25. ARRANGE FOR TRANSPORTATION, TREATMENT and/or DISPOSAL OF RECOVERED OIL AND OILY WASTES – Determine characterization, packaging and transportation requirements for the candidate treatment/disposal facilities 26. COMPLETE CLEANUP OPERATIONS AND OBTAIN CLEARANCE FROM REGULATORY AGENCIES - Obtain written agency clearance for each section of shoreline as cleanup is completed
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Villa Ridge Area Response Zone Appendix
7.7
Appendix 7: ERAP
Maps and Diagrams Maps and diagrams begin on the next page.
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Madison St. Charles
Calhoun
Lincoln
BLUE LINE - BL02 GOLD LINE - GD03 VILLA RIDGE RESPONSE Madison ARERA ICP
Montgomery
St. Charles Warren
St. Louis City St. Louis
Missouri ROSEBUD
MANUAL, BLOCK 604
AM 610
MANUAL, BLOCK M303 B
MANUAL, BLOCK M303 A
MANUAL, BLOCK 633 AM 635
MANUAL, BLOCK 626 AM 631
CHECK B-2 MOV, BLOCK B-2 CHECK B-1 MANUAL,BLOCK ROSEBUD STA
MANUAL, BLOCK 614
MANUAL, BLOCK 615
AM 625
MANUAL, BLOCK 647
AM 650
MOV, BLOCK 651
MOV, BLOCK 660
MANUAL,BLOCK 303 MOV, BLOCK 665
AM 655 AM 661.00
AM 640
MANUAL, BLOCK VILLA MOV,BLOCK B12916B1 MANUAL, BLOCK 638
AM 645
MANUAL, BLOCK 649
MANUAL,BLOCK 655 MANUAL,BLOCK 656 A MANUAL, BLOCK 656 B MANUAL, BLOCK M-303
MANUAL,BLOCK BBOY-4 MANUAL, BLOCK DEHB 45 MANUAL, BLOCK DEHB 46 MANUAL,BLOCK DEHB 44 MANUAL,BLOCK PBFLD-BK1 MANUAL, BLOCK AM 679 678 MOV,BLOCK 674 AM 676.7 MANUAL, BLOCK MANUAL, BLOCK 674
E. St. Louis Terminal
St. Clair
AM 670 MOV, BLOCK 671 MOV, BLOCK 670
AM 665
MANUAL,BLOCK EAST MERREMAC 2
Legend
Gasconade
Marker Franklin
Illinois
Valves Jefferson
MANUAL, BLOCK Monroe
MOV, BLOCK CHECK Pump Stations Terminals Pipelines GD-03 BL-02 Crawford
Crawford
Document Path: M:\Mapping\Erin\Working_Projects ADM095_SUPDISOB\BLUE_GOLD\BLUE_GOLD_ST_LOUIS_ICP.mxd Last Updated: 5/3/2016
Washington
Villa Ridge Area Response Zone Appendix
7.8
Appendix 7: ERAP
Response Forms Incident Report Form ICS 201-1 – Incident Briefing Map/Sketch ICS 201-2 - Summary of Current Actions ICS 201-3 - Current Organization ICS 201-4 – Resource Summary ICS 201-5 - Site Safety and Control Analysis Weather Report ICS 202 – Incident Objectives ICS 203 – Organization Assignment List ICS 211 - Check-In List Spill Trajectory Form
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MIDSTREAM OPERATIONS – HEALTH & SAFETY EMERGENCY RESPONSE PREP – COMPANY INCIDENT REPORT FORM Company, Agency and environmental notifications must be made quickly. Do NOT wait for all incident information before calling the National Response Center at 800-424-8802. Use this form to record as much incident information as possible. Communicate within 30 to 60 minutes of discovery time. Use the Emergency Notifications Log to document all communication, any additional information and distribution.
I. INCIDENT TYPE A. Check all that apply: Release B. REPORTING PARTY Name/Title: Company: Address:
Security
Fire
City, State Zip:
Other (Specify) C. SUSPECTED RESPONSIBLE PARTY Name/Title: Company: Address: City, State Zip:
Call Back #: Call Back #: D. Calling for the Responsible Party? Yes No II. INCIDENT LOCATION INFORMATION Incident Location: Terminal Pump Station Vessel Pipeline Truck Rail Owner Name: Operator Name: Address: 3010 Briarpark Dr; PWC 07-7330-34 Address: City, State, Zip: Houston, TX 77042 City, State, Zip: County/Parish: Hwy or River Mile Marker: Section-Township-Range: Latitude Longitude Dist./Dir. to Nearest City: Facility Storage Capacity: (bbls) Container Type ( AST/ UST) Container Capacity (bbls) Site Supervisor/Contact: Call Back #: III. INCIDENT DESCRIPTION & IMPACTS Date/Time Discovered: Discovered by: Material Released: Quantity Released: (bbls/lbs) Duration of the Release: Weather Conditions: F Quantity to Surface Water: Temperature: Humidity: Off Company Property? Yes No Wind Speed: Direction: Evacuations: Yes No # Evacuated: Name of Surface Water Fire: Yes No Distance to Water: (ft/mi) # Hospitalized: Explosion: Yes No # of Injuries: Media coverage expected? Yes No # of Fatalities If Operator error, has Drug and Alcohol program been initiated? DOT jurisdiction event? Yes No Yes No If DOT event, list those completing Drug and Alcohol testing? Incident description (Including Source and or Cause of the Incident)
Impacted area description
Damage description and estimate ($, days down, etc.)
Actions taken to correct, control or mitigate (Change in Security Level, FSP and/or ERP Implemented, etc.)
Blank Form Retention: Completed Form Retention:
ADM090/ MAX 12Y HSE975/5Y
Blank Form Location: Completed Form Location:
Livelink; TPTN-H/S-LibPolProc-Frm/Temp-EPR/PREP-IRF Livelink; Facility files
Effective Date: MAR-2012 PREP-IRF Page 1 of 3
MIDSTREAM OPERATIONS – HEALTH & SAFETY EMERGENCY RESPONSE PREP - INCIDENT REPORT FORM Agency/Person Contacted
Notified By
Office Phone
Cell Phone
Other Phone
Date & Time Notified
Log #
Comments
IV. EMERGENCY NOTIFICATIONS - LOG Follow-Up: Yes No
800-231-2551
Duty Officer/
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Blank Form Retention:
ADM090/ MAX 12Y
Blank Form Location:
Livelink; TPTN-H/S-LibPolProc-Frm/Temp-EPR/PREP-IRF
Completed Form Retention:
HSE975/5Y
Completed Form Location:
Livelink; Facility files
Effective Date: Jan.31,2012 PREP-IRF
Page 2 of 3
MIDSTREAM OPERATIONS – HEALTH & SAFETY EMERGENCY RESPONSE PREP - INCIDENT REPORT FORM Agency/Person Contacted
Notified By
Office Phone
Cell Phone
Other Phone
Date & Time Notified
Log #
Comments Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
Follow-Up: Yes No
V. ADDITIONAL INFORMATION
** Alternate NRC contact information: Fax: 202-267-2165, TDD: 202-267-4477, or e-mail:
[email protected]
VI. PREPARED BY AND DISTRIBUTION Prepared by:
Date:
IMPACT Entry Complete:
Yes No
* Notify the appropriate Company DOT Coordinator to complete the PHMSA FORM F 7000-1, as applicable.
Blank Form Retention:
ADM090/ MAX 12Y
Blank Form Location:
Livelink; TPTN-H/S-LibPolProc-Frm/Temp-EPR/PREP-IRF
Completed Form Retention:
HSE975/5Y
Completed Form Location:
Livelink; Facility files
Effective Date: Jan.31,2012 PREP-IRF
Page 3 of 3
Villa Ridge Area Response Zone Appendix
ICS 201-1 - Incident Briefing Map/Sketch Incident Name:
Appendix 7: ERAP
Version Name: Period:
/
/
:
to
/
/
:
Incident Map/Sketch
Situation Summary and Health and Safety Briefing
Approved By Incident Commander: Prepared By: ICS 201-1 – INCIDENT BRIEFING MAP/SKETCH
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Villa Ridge Area Response Zone Appendix
ICS 201-2 - Summary of Current Actions Version Name: Incident Name: Period: / / Current and Planned Objectives
Date/Time
Appendix 7: ERAP
:
to
/
/
:
Current and Planned Actions Action/Event/Notes
Approved By Incident Commander:
Date: Date:
Prepared By:
At:
ICS 201-2 – SUMMARY OF CURRENT ACTIONS
INCIDENT ACTION PLAN SOFTWARETM
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/
:
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Villa Ridge Area Response Zone Appendix ICS 201-3 - Current Organization Incident Name:
Version Name: Period: / /
Appendix 7: ERAP
:
to
/
/
:
Federal OSC Safety Officer State OSC
Liaison Officer Incident Commander
Public Information
Operations Section Chief
Logistics Section Chief
Planning Section Chief
Prepared By:
At:
ICS 201-3 – CURRENT ORGANIZATION
INCIDENT ACTION PLAN TM SOFTWARE
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/
:
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Finance Section Chief
Page
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Villa Ridge Area Response Zone Appendix ICS 201-4 – Resource Summary Incident Name: Resource Type/ Quantity Supplier ID Description
/
Version Name: Period: / /
Ordered
Prepared By:
At:
ICS 201-4 – RESOURCE SUMMARY
INCIDENT ACTION PLAN TM SOFTWARE
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Appendix 7: ERAP
:
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Villa Ridge Area Response Zone Appendix ICS 201-5 - Site Safety and Control Analysis
Appendix 7: ERAP
Version Name:
Incident Name:
Period: / / : to / / : Site Control 1. Is Site Control set up? Yes No 2. Is there an on-scene command post? Yes No If so, where? 3. Have all personnel been accounted for? Injuries: Fatalities: Yes No Don’t Know Unaccounted: Trapped: 4. Are observers involved, or rescue attempts planned? 5. Are decon areas setup? Yes No If so, where? Observers: Yes No Rescuers: Yes No Hazard Identification 1. Electrical line(s) down or overhead? 2. Unidentified liquid or solid products visible? Yes No Yes No Remarks: Remarks: 3. Wind direction across incident: 4. Is a safe approach possible? Yes No Towards your position Away from your position Remarks: Wind Speed: 5. Odors or smells? Yes No 6. Vapors visible? Yes No Remarks: Remarks: 7. Holes, ditches, fast water, cliffs, etc. nearby? 8. Fire, sparks, sources of ignition nearby? Yes No Yes No Remarks: Remarks: 9. Is local traffic a potential problem? 10. Product placards, color codes visible? Yes No Yes No Remarks: Remarks: 11. Other Hazards? Yes No 12. As you approach the scene from the upwind Remarks: side, do you note a change in the status of any of the Yes No above? Remarks: Hazard Mitigation 1. Entry Objectives:
2. Warning sign(s), barriers, color codes in place? 3. Hazardous material being monitored? Yes 3a. Sampling Equipment: 3b. Sampling location(s): 3c. Sampling frequency: 3d. Personal exposure monitoring: 4. Protective gear / level: 4a. Gloves: 4b. Respirators: 4c. Clothing: 4d. Boots: 4e. Chemical cartridge change frequency:
Yes No
Prepared By:
At:
ICS 201-5 – SITE SAFETY AND CONTROL ANALYSIS
INCIDENT ACTION PLAN SOFTWARETM
HSE025/DIS
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Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
Weather Report Incident:
Prepared By:
Period:
Version Name:
at
Present Conditions Wind Speed:
Wave Height:
Wind Direction From The:
Wave Direction:
Air Temperature:
Swell Height:
Barometric Pressure:
Swell Interval:
Humidity:
Current Speed:
Visibility:
Current Direction Toward:
Ceiling:
Water Temperature:
Next High Tide (Time):
Next Low Tide (Time): Next Low Tide (Height): Sunset:
Next High Tide (Height): Sunrise: Notes:
24 Hour Forecast Sunrise:
Sunset:
High Tide (Time):
High Tide (Time):
High Tide (Height):
High Tide (Height):
Low Tide (Time):
Low Tide (Time):
Low Tide (Height):
Low Tide (Height):
Notes:
48 Hour Forecast Sunrise:
Sunset:
High Tide (Time):
High Tide (Time):
High Tide (Height):
High Tide (Height):
Low Tide (Time):
Low Tide (Time):
Low Tide (Height):
Low Tide (Height):
Notes:
1997-2012 TRG/dbSoft, Inc.
Weather Report
HSE025/DIS
Revision: May 2016 © The Response
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Villa Ridge Area Response Zone Appendix ICS 202 – Incident Objectives Incident Name: Overall and Strategic Objectives
Version Name: Period: / /
Appendix 7: ERAP
:
Objective Ensure the Safety of Citizens & Response Personnel Identify hazard(s) of emitted material Establish site control (hot zone, warm zone, cold zone and security) Consider evacuations, as needed Establish vessel and/or aircraft restrictions Monitor air in impacted areas Develop site safety and health plan for response personnel Ensure safety briefings are conducted
to
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:
Assigned To
Status
Control the Source Complete emergency shutdown Conduct firefighting Initiate temporary repairs Transfer and/or lighter product Conduct salvage operations, as necessary Manage Coordinated Response Effort Complete or confirm notifications and provide updates as required Establish a unified command organization and facilities (Command Post, etc.) Ensure local and tribal officials are included in response organization Initiate emergency response Incident Action Plans (IAP) Ensure mobilization and tracking of response resources & personnel Complete documentation Evaluate planned response objectives vs. actual response (debrief) Maximize Protection of Environmentally-Sensitive Areas Implement pre-designated response strategies Identify resources at risk in impacted and potential impacted areas Track pollutant movement and develop trajectories/plume modeling Conduct visual assessments (i.e., over-flights) Develop/implement appropriate protection tactics Contain and Recover Spilled Material Deploy oil containment boom at the spill source Deploy containment boom at appropriate collection areas Conduct open water skimming with vessels Evaluate time-sensitive response strategies (i.e., dispersants, in-situ burning) Develop disposal plan Prepared By: ICS 202 – INCIDENT OBJECTIVES
HSE025/DIS
At:
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INCIDENT ACTION PLAN SOFTWARE
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Villa Ridge Area Response Zone Appendix
ICS 202 – Incident Objectives Incident Name:
Version Name: Period: / /
Appendix 7: ERAP
:
to
Objective Recover and Rehabilitate Injured Wildlife Establish oiled wildlife reporting hotline Conduct injured wildlife search and rescue operations Setup primary care unit for injured wildlife Operation wildlife rehabilitation center Initiate citizen volunteer effort for oiled bird rehabilitation
/
/
Assigned To
: Status
Remove Oil from Impacted Areas Conduct appropriate shoreline cleanup efforts Clean oiled structures (piers, docks, etc.) & oiled vessels Minimize Economic Impacts Consider tourism, vessel movements, and local economic impacts throughout response Protect public and private assets, as resources permit Establish damage claims process Keep Stakeholders Informed of Response Activities Provide forum to obtain stakeholder input and concerns Provide stakeholders with details of response actions & concerns and issues, and address as practical Provide elected officials details of response actions Keep the Public Informed of Response Activities Provide timely safety announcements Establish a Joint Information Center (JIC) Conduct regular news briefings Manage news media access to spill response activities Conduct public meetings, as appropriate Minimize Business Interruption Identify business interruption and potential business interruption issues Notification of joint venture partners Assist with internal/external investigations Operational Period Command Emphasis (Safety Message, Priorities, Key Decisions/Directions)
Approved By
Prepared By: ICS 202 – INCIDENT OBJECTIVES
HSE025/DIS
At:
/
/
Date: Date: Page
:
INCIDENT ACTION PLAN SOFTWARE
Revision: May 2016 © The Response
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Villa Ridge Area Response Zone Appendix
ICS 202 – Incident Objectives
Appendix 7: ERAP
Version Name:
Incident Name:
Period:
/
/
:
to
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:
Overall and Strategic Objectives Objective
Assigned To
Status
Operational Period Command Emphasis (Safety Message, Priorities, Key Decisions/Directions)
Incident Action Plan Components ICS 202 Response Objectives
ICS 206 Medical Plan
ICS 204 Assignment List ICS 203 Organization Assignment List / ICS 207 Organization Chart ICS 205 Communications Plan
ICS 208 Site Safety Plan Weather Report Incident Map Approved By
Prepared By: ICS 202 – INCIDENT OBJECTIVES
HSE025/DIS
At:
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/
Date: Date: Page
:
INCIDENT ACTION PLAN SOFTWARE
Revision: May 2016 © The Response
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Villa Ridge Area Response Zone Appendix
ICS 203 – Organization Assignment List
Appendix 7: ERAP
Version Name:
Incident Name:
Period:
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Incident Commander(s) and Command Staff Federal OSC State OSC Local OSC Incident Commander Deputy Incident Commander Public Information Officer Safety Officer Liaison Officer Agency/Organization Representatives
Operations Section Operations Section Chief Operations Section Deputy Staging Area Manager
:
Planning Section Planning Section Chief Planning Section Deputy Resource Unit Leader Situation Unit Leader Documentation Unit Leader Environmental Unit Leader Demobilization Unit Leader Logistics Section Logistics Section Chief Logistics Section Deputy Support Branch Director Supply Unit Communications Unit Leader Facilities Unit Leader Ground Support Unit Leader Medical Unit Leader Food Unit Leader Section
Finance/Administration Section Finance Section Chief Finance Section Deputy Compensation/Claims Unit Leader Procurement Unit Leader Cost Unit Leader Time Unit Leader Other Sections/Positions Position
Person
Approved By Planning Section Chief: ICS 203 – Organization Assignment List TM INCIDENT ACTION PLAN SOFTWARE
HSE025/DIS
Prepared By: Page
At: of
Revision: May 2016 © The Response
© The Response
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Date: Date: / : © 1997-2016
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Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
ICS 211 - Check-In List Area:
Incident Name: Description/ Name (Last, First)
Company / Agency
Time In Leader Name
ICS 211 - Check-In List INCIDENT ACTION PLAN SOFTWARE™
HSE025/DIS
Personnel/ Equipment Resource Type Equipment ID
Prepared By: Page
Demob Time
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Villa Ridge Area Response Zone Appendix
Appendix 7: ERAP
Spill Trajectory Form
HSE025/DIS
Revision: May 2016 © The Response
© The Response
A7-28 PaPa
