Laserfiche WebLink
CE� <br /> FNJUL D s 1- <br /> Sulu <br /> V <br /> EMERGENCY RELEASE FOLLOW-UP NOTICE REPORTING FOR IRpy1�9EN y <br /> BUSINESS NAME FACILITY EMERGENCY CONTACT&PHONE NU V1C ST <br /> Corn Products , Stockton Plan Roger Hoffdahl (209 982 1920 <br /> INCIDENT MO DAY YR 0 TIME OES <br /> DATE {) 6 2 2 1 0 ° 0 g 3 0 (use 24 hr time) CONTROL NO. 11101317 <br /> 8 5 <br /> INCIDENT-ADDRES§--LOCATION - . - CITY1-COMMUNITY- -COUNTY--------ZIP <br /> ---- _....--- .... .. . <br /> 1021 Industrial Drive Stockton San Joaquin 95206 <br /> CHEMICAL OR TRADE NAME (print or type) CAS Number <br /> NALCO 3DT289 Cooling Water Treatment 7664-38-2 -A <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFI- <br /> 40 CFR 355, APPENDIX A 11 . CATION UNDER 42 U.S.C. Section 9603(a) <br /> PHYSICAL STATE CONTAINED PHYSICAL STATE RELEASED QUANTITY RELEASED <br /> -SOLID ❑LIQ610 ❑GAS ❑SOLID ®LIQUID ❑ GAS 5-1.0 gallons <br /> ENVIRONMENTALCONTAMINATION TIMEOF RELEASE DURATiON OF RELEASE <br /> ❑AIR ❑WATER UGROUND❑OTHER 09Q0 -.9-DAYS$H0URS 1MINU <br /> ACTIONS TAKEN <br /> Upon d7 scaver trans ort driver shut the delivery pump on his truck <br /> off. Spilled liggTd was contained by the driver. Hazardous Waste Re- <br /> sponse contractor hire b- • NALCO to cleanup. Absorbent used and drummed <br /> . or disposal . Cleanup complete by :1500 hrs . <br /> Spill occurred on pavement adjacent to cooling tower, no release to <br /> i <br /> soil , storm drain and/or industrial sewer drains, <br /> i <br /> KNOWN OR ANTICIPATEDHEALTH EFFECTS (Use the comments section for addition information) <br /> ❑ ACUTE OR IMMEDIATE(explain) skin contact corrosive H 1.8 <br /> ❑ CHRONIC OR DELAYED(explain) <br /> 0 NOTKNOWN (explain) <br /> i <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> Lim <br /> COMMENTS (INDICATE SECTION (A-G)AND ITEM WITH COMMENTS ORADDITIONAL INFORMATION) j <br /> Norx--omer enc o i i a <br /> SJ County CUPA Environmental Health Det and California State Warnin <br /> Center OES, contact Ron ,report # 10-3785. - On site attendance during <br /> cleanup and inspec i.on by County RERS, Ray Von Flue. <br /> CERTIFICATION: I certify under penalty of law that I have personally examined and I am familiar with the information <br /> I submitted and believe the submitted infomnation is true,am rate,and complete. <br /> REPORTING FACILITY REPRESENTATIVE (print ortype) Roger W Hof da <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE ATE: <br />