Emergency Response and Training Solutions

Incident Response Form

ERTS Project # 09162009DIPA2602 ERTS Ticket # 2602 Customer Claim #

Pre-Assessment

Date 9/17/09 Time 1400 EST Project Manager Aal’on Wickham

Incident Reported by Dan Chimino of Halliburton -

Company

Contact Person Information: Phone number: 724-541-6053 x Fax Number:

E-mail: daniel.chimino@halliburton.com Additional:

Incident occurred: [~ In transit (over the road, rail, etc.) [~ Clients’ facility [~ Clients’ customer facility

[~ Other (specify) ~

Date and time of release: 9/16/09 __ I~Unknown Date and time of Discovery: 9/16/09 1605

DATE TIME DATE TIME

Location of incident: Cabot Oil & Gas, Troy Road, Dimock, Pennsylvania

Initial incident description: Lubricant & water solution released into stream

Reported Quantity Released: 1200 Gallons

Any injuries or evacuations? DYes [~No

On site Contact Dan Chimino

Affiliation Halliburton

Phone number 724-541-6053

On site Contact

Phone number

If yes, describe

Driver’s name

Phone number

Other Contact on site

Affiliation

Phone number

Vehicle Information: [] Tractor-Trailer [] Cargo Tank [] Tank Car [] Other__

Tractor number Trailer number Unit number

Container Type: [] Saddle Tank [] Tank [] Tote [] Drum

[]Other__ Size of container marked __

Performance Package Markings (i.e. UN1A/X1-8/25/96USA)_

Factors contributing to release: [] Equipment Failure [] Motor Vehicle Accident -

[] Possible Shipper Error - [] Other__

Materials Involved: []Hazardous

Proper Shipping Name: UN

Proper Shipping Name: UN

[]Non-hazardous []Diesel fuel/oil

HAZ Class PG RQ

HAZ Class PG RQ

[] Other

Significant Chemical Hazards/Risk: __

Is the MSDS Attached?

Has the Bill of Lading been provided?

Does the shipper require immediate notification?

Is response contractor required? [] Yes [] No Contractor: Northridge

[]Yes

[]Yes

[]Yes

[] Network

[]No

[]No

[]No

[] Non-network

[] DOT 5800.1 Form required as per 49 CFR 171.15 Comments__

Initial/Immediate Emergency Actions Taken: ERTS dispatched a network contractor to the site.

HESI302993
Regulatory Notifications

Agency

[] NRC

[] EPA

[] State Environmental Agency

[] State Emergency

Management Agency

Law Enforcement Agency

[] Fire Department

[] County LEPC

Notified by Date Time Contact Case/Ref. No.

Additional Comments:

Post Assessment

Release description: Re|ease impacted a sma|| ~tream and a wet|and area.

Actual volume/amount of material released: ]200 Gallons

Surface water affected? []Yes

Drain connected to sanitary sewer? []Yes

Drain connected to storm sewer? []Yes

[]No []Potential Describe

(If yes, Name of water body) ~

Length of affected area ~ Distance from spill location to surface water, in feet

[]No

(If yes, include name of wastewater treatment plant and/or street drain if known) __

[]No

(If yes, include number of drain or water body it discharges into, if known) __

Are there water wells, pipelines,

phone lines, or utility lines that

release might follow?

[]Yes []No

(If yes, describe),~

Ground water affected

Soil Contamination

Fish Kill

Wildlife affected

Vegetation affected

[]Yes [~No []Potential Describe~

[]Yes []No []Potential Describe~

[]Yes [~No []Potential Describe~

[]Yes [~No []Potential Describe~

[]Yes []No []Potential Describe~

Specific area of release [] Roadway [] Shoulder [] Drain [] Parking area [] Inside Trailer

[]Dock [] Median [] Roadside ditch [] Other

Surface Type []Soil []Asphalt []Cement []Gravel []Wood []Other

Weather Conditions

Injuries or exposures

(to public/bystanders)

Was anyone hospitalized?

Is this a reportable incident?

[]Clear []Rainy []Hot []Cold [] Snow [] Icy []Other~

[]Yes []No []Potential Describe ~

[]Yes []No If yes, number hospitalized?

[]Yes []No Explain~

HES1302994
Response Team Information

Contractor Northridge Group Contact Name Dave

Ad dress

City State __ Zip __

Phone number 570-473-8238 Fax number E-mail:

Amount and job description(s) of ERTS initially approved personnel responding to site

[] Supervisors/Foremen: 1 [] Technicians: [] Equipment Operators:

Description of ERTS initially approved contractor equipment dispatched to site

1 pickup truck

PPE Level

[] Vapor concentration (ppm)

Health and Safety

Site monitoring (if applicable) ~

[] Oxygen level (%) _ [] LEL for chemical of concern exceeded

Corrective Action

Corrective Action: On September 16, 2009, Northridge Group personnel arrived on site to provide technical

assistance and oversight at the request of Daniel Chimino. Baker Tank personnel had already responded to the

site and begun cleaning up the released product. Hay bales had been placed in the stream to form containment

areas and the product was being vacuumed from these areas into a new frac tank. Rain in the area washed the

lubricant product from the surrounding soil into the containment areas and aided the process. On September 17,

2009, Northridge Group personnel returned to the site and inspected the area. Baker Tank personnel had

worked through the night and had nearly completed the cleanup.

Manifests attached

Name of facility

Date

[--]Yes

Waste Disposal

[]No

Amount

Contact name

Add ress

City __ State __ Zip __

Comment pendin,q

Additional Information/Remarks

HESI302995