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Equipment Breakdown Report Template

This document reports an equipment breakdown at a company, including the permit numbers, equipment involved, location, date and time of occurrence and discovery, whether it was visible, time corrective action commenced and was successful, estimated emissions, cause, measures taken to correct and prevent recurrence, and initial notification details. The report assigns the burden of proof to the operator to show the breakdown was unavoidable and not due to negligence to be exempt from legal action under Rule 1100.

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Pin Santos
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240 views1 page

Equipment Breakdown Report Template

This document reports an equipment breakdown at a company, including the permit numbers, equipment involved, location, date and time of occurrence and discovery, whether it was visible, time corrective action commenced and was successful, estimated emissions, cause, measures taken to correct and prevent recurrence, and initial notification details. The report assigns the burden of proof to the operator to show the breakdown was unavoidable and not due to negligence to be exempt from legal action under Rule 1100.

Uploaded by

Pin Santos
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Report of Equipment Breakdown

Company Name: Permit Number(s): Equipment Involved:

Location of Property (Address, Lease, Field, Section, Township, Range): Date and Time of Occurrence: Date and Time of Discovery: Visible (Yes or No)

Time Corrective Action Commenced: Estimated Emissions: Pollutant: Cause of the Occurrence:

Date and Time Corrective Action Successful:

Estimated Emission Rate:

Measures Taken to Correct this Occurrence and Prevent its Recurrence:

Attach Photographs of Defective Equipment. Provide any additional information necessary to establish that this occurrence was the result of an unavoidable failure or malfunction. Rule 1100 Equipment Breakdown assigns the burden of proof to the source operator seeking exemption from legal action. An exception cannot be granted for an occurrence, which was the result of negligence.

Initial Notification:

Reported By: Reported To:

Date: Time:

Rule 1100 Notification (rev. 10.02.06)

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