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0 0 <br /> EMERGENCY RELEASE FOLLOW-UP NOTICE REPORTING FORM <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 11 Tim Van Domelen ( 209)858-2511 <br /> B TIME <br /> INCIDENT MO DAY YR SJ EH [Sheryl <br /> erson Spoken to: <br /> DATE 8-4-08 NOTIFIED 11:18 (use 24 hr time) /Ray Von Flue <br /> INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP <br /> u 16777 Howland Rd I I Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME (print or type) IF! <br /> mber7664-38-2 <br /> Phosphoric 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 ®LIQUID ❑GAS ❑ SOLID Z LI UID ❑GAS I Less than 1 gallon <br /> LlENVIRONMENTAL CONTAMINATION 11 TIME OF RELEASE DURATION OF RELEASE <br /> ❑AIR ❑ WATER® GROUND❑OTHER 10:20 DAYS HOURS 2 MINUTES <br /> ACTIONS TAKEN <br /> Leak was noticed coming from an elevated transfer pipe leading to the phos acid storage tank. Pumps were shut down and clamp <br /> was installed to temporarily stop the leak until permanent repairs could be made.Acid was neutralized and effected soil was <br /> removed and will be reused in the plant.Pipe has been replaced. <br /> dE AMOUNT OF HAZARDOUS WASTE CREATED '/4 cubic yard <br /> DISPOSITION OF HAZARDOUS WASTE Not hazardous waste,product reused in 21ant <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> M 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?No Control No. <br /> I- NRC Called?No Report No. <br /> 1 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 me n S&S M er <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE: P � <br />