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EMERGENCY RELEASE FOLLOW-UP NOTIC40' SAN JOAQUIN COUNTY EHD BUSINESS NAME FACILITY EMERGENCY CONTACT & PHONE NUMBER J.R. Simplot Company Tim Van Domelen ( 209 )858-2511 $ INCIDENT ADDRESS LOCATION TIME COUNTY ZIP [A INCIDENT MO DAY YR 11 OES OES DATE 10/14/10 NOTIFIED 17:52 (use 24 hr time) CONTROL NO. 10-6216 F CHEMICAL OR TRADE NAME (print or type) I Sulfuric Acid 98% CAS Number 7664-93-9 CHECK IF CHEMICAL 1S LISTED IN CHECK IF RELEASE REQUIRES NOTIFICATION 40 CFR 355, APPENDIX A ® UNDER 42 U.S.C. SECTION 9603 (a) ❑ PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED ❑ SOLID ® LIQUID [:]GAS ❑SOLID ® LIQUID ❑ GAS 11 APPROX I Gallon. ENVIRONMENTAL CONTAMINATION If TIME OF RELEASE DURATION OF RELEASE [—]AIR ❑ WATER ® GROUND ❑ OTHER 17:25 0 DAYS 0 HOURS l MINUTES ACTIONS TAKEN At approx 17:25 on 10/14/2010 a contractor spilled sulfuric acid from their truck during maintenance activities , approx 1 gallon reached the soil. The area was neutralized and the affected soil removed and will be reused in the granulation plant. Notification was made to San Joaquin OES & E"D and Cal-EMA KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments section for additional information) ® ACUTE OR IMMEDIATE (explain) Skin and eye contact- corrosivity ❑ CHRONIC OR DELAYED (explain) ❑ NOT KNOWN (explain) ADVICE REGARDING MEDICAL, ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS Flush any contacted areas of the body with large amounts of water. COMMENTS (INDICATE SECTION (A -G) AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) CERTIFICATION: I certify under penalty of law that I have personally examined and am familiar wii Believe the submitted information is true, accurate, and complete. REPORTING FACILITY REPRESENTATIVE (print or type) Ryan Mock, Environmental Specialist and SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE: 1D-Z//O INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP [A 16777 Howland Road Lathrop San Joaquin 95330 F CHEMICAL OR TRADE NAME (print or type) I Sulfuric Acid 98% CAS Number 7664-93-9 CHECK IF CHEMICAL 1S LISTED IN CHECK IF RELEASE REQUIRES NOTIFICATION 40 CFR 355, APPENDIX A ® UNDER 42 U.S.C. SECTION 9603 (a) ❑ PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED ❑ SOLID ® LIQUID [:]GAS ❑SOLID ® LIQUID ❑ GAS 11 APPROX I Gallon. ENVIRONMENTAL CONTAMINATION If TIME OF RELEASE DURATION OF RELEASE [—]AIR ❑ WATER ® GROUND ❑ OTHER 17:25 0 DAYS 0 HOURS l MINUTES ACTIONS TAKEN At approx 17:25 on 10/14/2010 a contractor spilled sulfuric acid from their truck during maintenance activities , approx 1 gallon reached the soil. The area was neutralized and the affected soil removed and will be reused in the granulation plant. Notification was made to San Joaquin OES & E"D and Cal-EMA KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments section for additional information) ® ACUTE OR IMMEDIATE (explain) Skin and eye contact- corrosivity ❑ CHRONIC OR DELAYED (explain) ❑ NOT KNOWN (explain) ADVICE REGARDING MEDICAL, ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS Flush any contacted areas of the body with large amounts of water. COMMENTS (INDICATE SECTION (A -G) AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) CERTIFICATION: I certify under penalty of law that I have personally examined and am familiar wii Believe the submitted information is true, accurate, and complete. REPORTING FACILITY REPRESENTATIVE (print or type) Ryan Mock, Environmental Specialist and SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE: 1D-Z//O