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EMERGENCY RYMASE FOLLOW-UP NOTICE PORTING FORM <br /> A BUSINESS NAME FACILITY EMERGENCY CMTACT&PHONE NUMBER <br /> J.R_Simplot Environmental Manager—209-858-2511 <br /> $ INCIDENT MO DAY YR TIME OES <br /> DATE 2/3/2008 OES <br /> NOTIFIED 1510 (use N hourtime) CONTROL NO. 08-1048 <br /> C INCIDENT ADDRRESS LOCATION CITYPCOMMUNITY COUNTY ZIP <br /> 16777 Howland Rd. Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME(print or type) CAS NUMBER <br /> Sulfur Dioxide 7446-09-5 <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFICATION <br /> D40 CFR 355,APPENDIX A [ x j UNDER 42 USC SEC 9605(a) [ ] <br /> PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED <br /> 2 lbs <br /> [ _ SOLID _ LI_ U _ <br /> ID _ _GASjj SOLID.1. 1 LIQUID GAS.____. <br /> ENVIRONMENTAL CONTAMINATION TIME OF RELEASE DURATION OF RELEASE <br /> AIR WATER[ ]GROUND OTHER 1450 60 MINUTES <br /> ACTIONS TAKEN <br /> A small SO2 leak was located under the insulation on the ducting from boiler#3.Repairs have been made and location of <br /> repair is being monitored <br /> E <br /> F IKNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> [X] ACUTE OR IMMEDIATE(Explain)Respiratory Discomfort <br /> [ ] CHRONIC OR DELAYED (Explain) <br /> C l NOT KNOWN(Explain) <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> G Not Required <br /> COMMENTS: INDICATE SECTION(A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION <br /> H <br /> CERTIFICATION: I hereby certify under penalty of law that I have personally examined and I am familiar with the <br /> information submitted and believe the submitted information is true,accurate and complete. <br /> REPORTING FACILITY REPRESENTATIVE <br /> (print or type) Tim Van Domelen <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE ,r DATE 2/8/2008 <br />