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Pilot/Flying J #617- Lodi �� OPERATORS �� oti ft1 �b/,� (�(J 1�L1 /G / Rev.12-05-2007 Instructions:Use this log to record any smaller"controllable spills"at your facility.These spills must be of gasoline or Diesel product only(no used motor oil or other fluid), less than 1 gallon in size,sifting up on concrete or asphalt(not actively migrating). Use the FM-186 spill response kits as directed. Responders must have completed FM-186 spill response training by a certified FM-186 trainer. After responding to the spill,complete an entry into this form. Start by noting the date and time of the spill,where it occurred, and your name. If the spill response is complete,write YES to confirm it has been mitigated.You can use the Comments/ Observations column to note any other important information. For larger"aggressive spills,"(which are generally over 1 gallon and spreading); product releases to secondary containment structures such as sumps or manways; spills of any size that have impacted the environment;or spills of petroleum substances other than gasoline or Diesel fuel(such as used oil);use the facility's one-page Spill/Release Response Log. Questions? Contact your manager and/or Designated Operator. Date Time Location Responder Mitigated? Comments I Observations ❑am m ❑am R pm 0 a 13 pm ❑am ❑pm 1 , ❑am o pm - A , ❑am ❑ pm ❑am ❑pm ❑am ❑ pm ❑am l7 pm ❑am 0 pm ❑am ❑pm 0 a 0 p ,v ❑am ❑pm cam 0 pm Keep uncompleted forms by the FM-186 Spill K/t on a Clipboard.