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0 9 <br /> EMERGENCY RELEASE FOLLOW-UP NOTICE REPORTING FORINT <br /> San Joaquin County Environmental. Health <br /> For spills to the environment or employee injuries from chemicals <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 SJ EH Person Spoken to: <br /> DATE 8-8-08 11 NOTIFIED 1400 (use 24 hr time) Sheryl/Michelle Henry <br /> INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP <br /> 16777 Howland Rd Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME (print or type) CAS Number 7664-93-9 <br /> Sulfuric Acid <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 [A LIQUID ❑GAS ❑ SOLID Z LIQUID ❑GAS Approx. 100 Gallons <br /> ENVIRONMENTAL CONTAMINATION I I TIME OF RELEASE DURATION OF RELEASE <br /> ❑AIR ❑ WATER®GROUND❑OTHER 1335 DAYS HOURS 20 MINUTES <br /> ACTIONS TAKEN <br /> During acid transfer from various plant locations a check valve failed and resulted in overflowing a temporary tank.Valves were <br /> immediately closed and check valve will be replaced. The acid was neutralized during response activities,affected soil was <br /> removed and will be reused in the pellet plant.Procedures have been put in place to ensure valves are closed and not to rely on <br /> check valves. <br /> E AMOUNT OF HAZARDOUS WASTE CREATED:Not Hazardous Waste,Approx 20 yds <br /> DISPOSITION OF HAZARDOUS WASTE:Not Hazardous Waste,soil was removed and will be reused in plant. <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> ® ACUTE OR IMMEDIATE(explain)Skin or eye contact-corrosive <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 clear water. <br /> COMMENTS (INDICATE SECTION(A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) <br /> B. State OES Called?Yes Control No.08-5758 <br /> NRC Called?Yes Report No. 879994 <br /> j CERTIFICATION:I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe <br /> the submitted information is true,accurate,and complete. <br /> REPORTING FACILITY REPRESENTATIVE(print or type) Tim Van Domelen, cS Manage <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE: $� �� <br />