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EMERGENCY RELEASE FOLLOW-UP NOTICE REPORTING FORM <br /> A BUSINESS NAME FACILITY EMERGENCY CONTACT&PHONE NUMBER <br /> J.R. Simplot Company EHS&S Manager 209-858-2511 <br /> B INCIDENT MO DAY YR TIME OES <br /> DATE 01/19/08 OES <br /> NOTIFIED 1725 CONTROL NO.08-0570 <br /> INCIDENT CITYPCOMMUNITY COUNTY ZIP <br /> Sulfuric Acid Spill Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME CAS NUMBER <br /> Sulfuric Acid 7664-93-9 <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFICATION <br /> D 40 CFR 355,APPENDIX A [XX] UNDER 42 USC SEC 9605(a) [ ] <br /> PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED <br /> SOLID XX LIQUID[ ]GAS SOLID XX LIQUID[ ]GAS -Approx.3 Gallons <br /> ENVIRONMENTAL CONTAMINATION TIME OF RELEASE DURATION OF RELEASE <br /> [ ]AIR[ ]WATER[XX]GROUND[ ] Approx. 1640 hrs Unknown <br /> OTHER <br /> ACTIONS TAKEN <br /> A small leak was observed coming from a pump associated with tank#9.The approx.3 gallon leak was contained,the leaking <br /> pump seal was repaired and the acid containing soil was removed and beneficially reused in the fertilizer granulation plant for <br /> its acid value. <br /> E - <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> [xx] ACUTE OR IMMEDIATE(Explain)Skin and eye contact-Corrosive <br /> F <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> G 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 /> H B: State OES contacted at 1725,County OES contacted at 1650,County Env.Health contacted at 1705 <br /> Control#08-0570 <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 /> i <br /> REPORTING FACILITY REPRESENTATIVE(print or type) <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE / 2 Oiff <br />