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' HECISVM <br /> JUN 17 261.5 <br /> E!@'W6 BONMEWANI <br /> EMERGENCY RELEASE FOLLOW - UP NOTICE REPORTING FOR�4 <br /> BUSINESS NAME Carpenter CO. FACILITY EMERGENCY CONTACT& PHONE NUMBER <br /> P Michael Pariss1 (209 )982-4800 <br /> INCIDENT MO DAY YR TIME OES <br /> DES 1 1 1 (use 24 hr time) CONTROLNO. 1 5 3 <br /> DATE 6 <br /> 1. 10 <br /> 0 1 <br /> INCIDENT ADDRESS LOCATION CITY/ COMMUNITYCOUNTY ZIP <br /> 17800 South Harlan Road Lathrop San Joaquin 95330 <br /> CHEMICAL OR TRADE NAME (print or type) AS Number <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFI - ❑ <br /> 40 CFR 355, APPENDIX A CATION UNDER 42 U.S.C. Section 9603(a) <br /> pHnICAL <br /> IT� IN� PLISTATE SIQUANTITY <br /> RELEASED <br /> SOLD X IQU DGAS InSODLIQUIDt GAS 25 gallons <br /> ENVIRONMENTAL <br /> CONTAMINATION TIME OF RELEASE I DURATION OF RELEASE <br /> QAIR OWATER QGROUNDQX OTHER 8:00 PM —DAYS —HOURSX MINUTE <br /> U1 I <br /> ACTIONS TAKEN <br /> Product contained and removed for proper disposal <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments section for addition information) <br /> ACUTE OR IMMEDIATE (explain) <br /> Xa CHRONIC OR DELAYED (explain) <br /> Q NOTKNOWN (explain) <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> COMMENTS (INDICATE SECTION (A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) <br /> N/A <br /> CERTIFICATION: I certify under penalty of law that I have personally examined and I am familiar with the information <br /> submitted and believe the submitted information is true, accurate, and comp late. Michael Parlssl <br /> REPORTING FACILITY REPRESENTATIVE (print or type) <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE DATE: 6/11/2015 <br />