FORM C
SITE CLEAN-UP/REMEDIATION ASSESSMENT REPORT (FORM C)
Company Name
*
Date of Assessment
*
-
Day
-
Month
Year
Date
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
Site Name
*
OML
*
Date/Time of Incident
*
-
Day
-
Month
Year
Date
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
Area and Depth of Impact
*
GPS FIELD POINTS
*
Total Length in meters
Length Surveyed in meters
Differential GPS
*
Yes
No
Spill Start Point GPS
*
Total Length in meters
Length Surveyed in meters
Spill End Point GPS
*
Total Length in meters
Length Surveyed in meters
Contaminated Media
*
Vegetation
Soil
Type option 4
Sediment
Inland Surface Water
Brackish Swamp Surface Water
Off shore Surface Water
Underground Water
Other
Date Clean‐up Programme Comenced
*
-
Month
-
Day
Year
Date
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
Method of Clean‐Up
*
Low Pressure Wash
Mannual
Mechanical
Surface Wash
Sorbents
Chemical Disparsant
Vacuum Skimming
Other
Estimated quantity of oil / containment recovered
*
Method of Debris Disposal
*
Controled Inciniration
Buried in lined pit
Chemical Treatment
Sanitary Landfill
Land farming
Other
Back
Next
Site Visual Observation
Nature of Soil
*
Show Heavy Impact
Medium Impact
Minimal Impact
Other
Nature of Surface Water
*
Oil Sheen Present
No Oil Sheen Present
Other
Nature of Vegetation
*
Withered
Withering
Luxuriant
Site Photos
*
Yes
No
Date Site clean‐up ended
*
-
Day
-
Month
Year
Date
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
Sample collected after the clean‐up program
*
Soil
Sediment
Water
Other
Result of Laboratory Analysis of Samples collected Pre/Post Remediation
*
Rows
Sample
Test Method
Result
Result
Parameter
TPH
BTEX
Trace Metals
Arsenic
Barium
Cadmium
Chromium
Copper
Mercury
Lead
Nickel
Zinc
Total Dissolved
Total suspended Solids
Indicate your consent to the processing of your personal data by NOSDRA as detailed in our Privacy Policy
*
Please verify that you are human
*
Submit
Print Form
Should be Empty: