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AGENCY RELEASE FOLLOW-UP NOTR S E P 1 J 21008 <br /> San Joaquin County Environmental Health ENV'fF143NMENI HEALTH <br /> - pERUBT/SERVICES <br /> BUSINESS NAME FACILITY EMERGENCY CONTACT&PHONE NUMBER <br /> J.R. Simplot Company Tim Van Domelen { 209)858-2511 <br /> $ TIME <br /> INCIDENT MO DAY YR OES OES <br /> DATE 9/10/08 11 NOTIFIED 1204 (use 24 hr time) CONTROL NO.08-6618 <br /> INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP <br /> 16777 Howland Road Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME (print or type) CAS Number 7664-93-9 <br /> Sulfuric Acid 98% 11 <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFICATION <br /> 40 CFR 355,APPENDIX A ® UNDER 42 U.S.C. SECTION 9603 a) ❑ <br /> PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED <br /> ❑ SOLID Z LIQUID ❑GAS 11 ❑ SOLID ® LIQUID El I Less Than 5 Gallons <br /> ENVIRONMENTAL CONTAMINATION TIME OF RELEASE DURATION OF RELEASE <br /> ❑AIR ❑ WATER M GROUND❑OTHER 1130 0 DAYS 0 HOURS I MINUTES <br /> ACTIONS TAKEN <br /> Backhoe operator struck an underground sulfuric acid line.Adjacent underground pipes were being removed in order to install <br /> new containment in the area.Currently pipes in this area are being relocated aboveground and a large containment project is <br /> underway. <br /> State and County OES Notified. <br /> E <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> CR ACUTE OR IMMEDIATE(explain)Skin and eye contact-corrosivity <br /> F ❑ CHRONIC OR DELAYED(explain) <br /> ❑ NOT KNOWN(explain) <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> Flush any contacted areas of the body with large amounts of water. <br /> G <br /> COMMENTS (INDICATE SECTION(A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) <br /> II <br /> CERTIFICATION:I certify under penalty of law that I have personally examined and am familiar with the information submitted and <br /> Believe the submitted information is true,accurate,and complete. <br /> REPORTING FACILITY REPRESENTATIVE(print or type)Tim Van Domclen,EHS&S Manager <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE—� DATE: ! oQ <br />