NC0081931_Incident Report Form_20180711

YADKIN
ENVIRONMENTAL INCIDENT REPORT FORM
Incident Number: (Assigned by EHS Dept: Y00439 High Rock Powerhouse
Nature of the Incident
❑
Non -Compliance with Laws and
❑
Spill Greater than 20 Liters
❑
Transportation hicident
Regulations
❑
Non -Compliance with Cube Corporate
❑
Complaint
❑
Other
Standard
❑
Non -Compliance with Cube Local
❑
Flora and Fauna Impact
®
Environmental Near Miss
Standard
Incident Details:
Incident Date
YYYY/MM/DD : 2018 July 06
Incident Time
HH:MM, 24 hr. clock): 07:45
Situation:
E New Situation
❑ On -going Situation
Released to Which Area? (Media):
❑
None
❑
Soil on Plant Site
❑
Water (Ocean)
❑
Building hiside
❑
Water (Estuary)
❑
Water (River)
❑
Paved Area
❑
Water (Ground)
❑
Water (Small Stream)
❑
Soil off Plant Site
E
Water (Lake)
❑
Other — Atmosphere
Material Released?(Parameter)
❑
Alkalinity
❑
Dioxins
❑
PCE
❑
Aluminum
❑
Dissolved Oxygen
❑
Settleable Soilids
❑
Ammonia
❑
Dissolved Solids (Total)
❑
Sulfates
❑
Arsenic
❑
Fecal Coliform
❑
Suspended Solids
❑
Asbestos Containing Material
❑
Flow
❑
TCE
❑
BOD
❑
Hexane
❑
Temperature
❑
COD
❑
Iron
❑
Toxicity
❑
Cadmium
❑
Lead
❑
Turbity
❑
Chlorides
❑
Magnesium
❑
Zinc
❑
Chlorine
❑
Mercury
❑
pH
❑
Color
❑
Nitrates
❑
Other — Anode baking combustion fumes.
❑
Copper
E
Oil / Grease
❑
❑
Cyanide (Free)
❑
PAH's
❑
❑
Cyanide (Total)
❑
PCB's
❑
Incident Occurrence —
Department: Yadkin I Specific Area / Equipment: High Rock Powerhouse
Release Point
®
I Building
❑
Outfall
❑
Other— Describe
❑
I Discharge Point
I ❑
I Source
Release Point ID (e.g. Outfall # and Bldg location.):
Severity of Incident Information
E I One-time event, not expected to reoccur
Could reoccur 1-3 times
❑ I Could reoccur 3-10 times per year
Could reoccur 10-20 times
❑ I Could reoccur more than 20 times per
Location: Sharepoint / EHS / Environmental Printed: 2/23/17 Pagel of 3

YADKIN
ENVIRONMENTAL INCIDENT REPORT FORM
Damage or Remediation Costs
❑
$0
❑
Between $10,000 and $99,999
❑
Greater than $500,000
(US Dollars)
(US Dollars)
(US Dollars)
®
Between $1 and $9,999
❑
Between $100,000 and $499,999
❑
NONE
(US Dollars)
(US Dollars)
Expected Penalties
E
$0
❑
Between $1,000 and $9,999
❑
Greater than $100,000
(US Dollars)
(US Dollars)
(US Dollars)
❑
Between $1 and $999
❑
Between $10,000 and $99,999
❑
NONE
(US Dollars)
(US Dollars)
Environmental Impact
❑ No Impact ❑ I Moderate ❑ I Severe and Irreversible
17 1 Minor n I Severe
Additional Severity of Incident Options Check the applicable boxes
❑ I Liquids — more than 100 liters spilled
Name of Person reporting the Incident: Jeff Henley Phone Number: 910-975-1576
What Occurred? (Please Drovide a brief description of the
At 7:45 AM on July 06 an oil sheen was observed in the tailrace at High Rock Powerhouse Unit 1. Clean up activities
were initiated immediately. A boat was launched and oil booms were deployed to contain the oil sheen and oil absorbent
material was distributed to absorb the oil.
Cube Hydro Management resources were notified immediately.
Once clean-up activities were started supervisors identified the source by 9:30 AM. The oil was observed coming
through a concrete construction joint on the tailrace pier between units 1 & 2 and originating from the oil pipe trench
inside the powerhouse.
The oil pipe trench collects oily water from the governors and/or wheel pits and is subsequently pumped out for proper
disposal. Evidently the concrete construction joint has deteriorated over time such that the oily water mixture was
released to the tailrace.
An oil absorbent berm was installed at the two construction joint areas in the pipe trench between Units 1 & 2 and Units
2&3.
The spill was estimated to be 6 ounces.
N. C. DEQ Department of Water Resources, Southeastern Emergency Response Center, and the National Emergency
Response Center were notified.
Corrective Actions to Prevent Reoccurrence:
Corrective Action Plan
Estimated Cost (US Dollars)
Person Responsible
Completion Date
Only enter if not entered in
(Last Name, First)
(YYYY / MM / DD)
previous incident report
Establish containment, remove oil
$8500
Henley, Jeff
Target: 2018/07/06
from the lake surface, pump out
Actual: 2018/07/07
and properly dispose of oily water
in pipe trench.
C:\USERS\BJSTRICKLAND\APPDATA\LOCAL\TEMP\NCoo81931-OTHER-7 11 2018 694889\NC0081931 -OTHER -
7 11 2018. DOC

YADKIN
ENVIRONMENTAL INCIDENT REPORT FORM
Properly dispose of booms, oil
absorbent, etc.
Included in previous action item
Henley, Jeff
Target: 2018/07/31
Actual:
Investigate installing concrete
$5000
Henley, Jeff
Target: 2018/10/31
berm at construction joints to
Actual:
prevent recurrence.
The High Rock Modernization
Funded by HR Project
Henley, Jeff
Target: 2018/10/31
Project will eliminate the oil
Actual:
pipes in the pipe trench.
c:\USERS\BJSTRICKLAND\APPDATA\LOCAL\TEMP\Nco081931-OTHER-7 11 2018 694889\NC0081931 -OTHER -
7 11 2018. DOC