ANNEX D

 

Sample Template for Interim Notifications of

Environmental Quality Limits Exceedances

 

 

Incident Report on Action Level or Limit Level Non-compliance

 

 

Project

 

Date

 

Time

 

Monitoring Location

 

Parameter

 

Action & Limit Levels

 

Measured Level

 

Possible reason for Action or Limit

Level Non-compliance

 

Actions taken / to be taken

 

Remarks

 

 

                                                                       

                                                                                    Location Plan

 

 

 

Prepared by:

 

 

 

 

 

 

Designation:

 

 

 

 

 

 

Signature:

 

 

 

 

 

 

Date: