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EMIRIGENCY RELEASE FOLLOW-UP NOTIC91 SAN JOAQUIN COUNTY ENVIRONMENATL HEALTH DEPARTMENT BUSINESS NAME _ FACILITY EMERGENCY CONTACT & PHONE NUMBER J.R. Simplot Company Tim Van Domelen ( 209)858-2511 g TIME INCIDENT MO DAY YR OES OES DATE 9/23/10 11 NOTIFIED 17:55 (use24hrtime) CONTROLNO.10-5728 CHEMICAL OR TRADE NAME (print or type) CAS Number 7664-93-9 Sulfuric Acid 98% 11 CHECK IF CHEMICAL IS 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 I I APPROX 2 OZ. ENVIRONMENTAL CONTAMINATION _ TIME OF RELEASE I DURATION OF RELEASE E]AIR ❑WATER ®GROUND ❑OTHER 17:15 0 DAYS 0 HOURS 20 MINUTES ACTIONS TAKEN At approx 17:15 on 9-23-10 a drip was seen'coming from a 98% sulfuric acid line valve. The drip was found to be from the packing material in the valve and dripping to soil. Pressure was released and containment placed under the dripping valve. The valve was replaced and affected soil removed. Notification was made to San Joaquin OES & EHD and Cal-EMA KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments section for additional information) ® ACUTE OR IMMEDIATE (explain) Skin and eye contact- corrosivity F 11 ❑ 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 with the information submitted and Believe the submitted information is true, accurate, and complete. REPORTING FACILITY REPRESENTATIVE (print or type) Ryan Mock, Environmental Specialist SIGNATURE OF REPORTING FACILITY REPRESENTATIVE J / _ DATE: z�/n INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP 16777 Howland Road Lathrop San Joa uin 95330 CHEMICAL OR TRADE NAME (print or type) CAS Number 7664-93-9 Sulfuric Acid 98% 11 CHECK IF CHEMICAL IS 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 I I APPROX 2 OZ. ENVIRONMENTAL CONTAMINATION _ TIME OF RELEASE I DURATION OF RELEASE E]AIR ❑WATER ®GROUND ❑OTHER 17:15 0 DAYS 0 HOURS 20 MINUTES ACTIONS TAKEN At approx 17:15 on 9-23-10 a drip was seen'coming from a 98% sulfuric acid line valve. The drip was found to be from the packing material in the valve and dripping to soil. Pressure was released and containment placed under the dripping valve. The valve was replaced and affected soil removed. Notification was made to San Joaquin OES & EHD and Cal-EMA KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments section for additional information) ® ACUTE OR IMMEDIATE (explain) Skin and eye contact- corrosivity F 11 ❑ 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 with the information submitted and Believe the submitted information is true, accurate, and complete. REPORTING FACILITY REPRESENTATIVE (print or type) Ryan Mock, Environmental Specialist SIGNATURE OF REPORTING FACILITY REPRESENTATIVE J / _ DATE: z�/n