State of Oregon: Department of Environmental Quality

LUST Incident Reporting Form

Notice (6/23/17): The OLPRR reporting tool is offline for maintenance. You have reached an alternative webpage to submit incident report information. Reporters will continue to receive an email confirming receipt and providing the incident log number. During this period DEQ responses may take up to 3 business days to complete. Please email hotinfo@deq.state.or.us with questions or problems, or call 503-229-5263 and ask to speak with the Heating Oil Tank or Leaking Underground Storage Tank Duty Officer. We apologize for any inconvenience or delays you may experience.

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Incident Information

Date Reported

Date Release Discovered

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Site Information

Site Type

Site Name

Site County

Site Street Number

Quadrant

If the quadrant comes after the street name, leave this field blank and include the quadrant in the street name field.

Site Street Name

Site Street Type

Site City

Site Zip Code

Site Phone

Reporter Information

Reported By

Company

Reported By Email

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Reported By Phone

Responsible Party

Responsible Party First Name

Responsible Party Last Name

Organization

Phone

Address

City

State

Zip Code

Site Assessment

Confirmation

Discovery

Cause

Source

Contaminants

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Heating Oil Unleaded Gasoline Leaded Gasoline

Misc. Gasoline Diesel (Motor Fuel) Waste Oil

Lubricant Solvent Other Pet. Dist.

Chemical MTBE Unknown Contaminant

Impacted Media

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Groundwater Surface Water Drinking Water

Soil Vapor Free Product

Site Comments

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