Clearwater Oil Company, Ltd.
Big Bear Lease No. 2 Production Facility
SAMPLE Spill Prevention, Control, and
Countermeasure (SPCC) Plan
Discharge Notification Form
*** Notification must not be delayed if information or individuals are not available.
Facility: Clearwater Oil Company Big Bear Lease No. 2 Production Facility
5800 Route 417, Madison, Louisiana 73506
Description of Discharge
Location of discharge
G stock, flare
G crude oil
* Describe other:
Appearance and description
G other (describe):
G Release confined to company property.
G Release outside company property.
** If water, indicate extent and body of water:
Describe circumstances of the release
Assessment of impacts and remedial actions
Disposal method for recovered material
Action taken to prevent incident from reoccurring
Version 1.0, 11/28/2005