Appendix 12 Incidental Report on Action Level or Limit Level Non-compliance

Project

Date

Time and Tidal status if relevant

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: _________________________