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JAN 25 '05 02:27PM HEIN7 )TOCKTON P.2i2 <br /> EMERGENCY RELEASE FOLLOW-UP NOTICE REPO"NG FORM <br /> BUSINESS MNAME FACILITY EMERGENCY CONTACT& PHONE NUMdE-R <br /> T p Keith Bardney (209) 932- 578 <br /> INCIDEJVT NEO DAY YR TINE O� <br /> DATE 0 1 C 7 0 5 Ott 1 0 0 0 (�24hrt'hx GONTROI — 5 0 6 0 2 <br /> U2800 <br /> CIDENT ADDRESS LOCAWN CTT�f/COMMUNITY Cotjwff z1F <br /> S . California St . St., Ire Sar .Jcaq yin 952u6 <br /> CHEi4i41CALGR TRADE NAME {print or type) CAS NEaber <br /> Sodium Hydroxide -30% 1310 "- 73 - 2 <br /> CHECK Ii= CHEMtCAL IS LISTED IN G"ECKIFRELEASE REQUIRES NOTIFI- � <br /> 40 CFR 355, APPENMX A <br /> CATION ANDER 42 U.S.C- Secbort96E)3(; } [,.E <br /> PHYSICAL STATE CONTAINED PHYMfCAL STATE RELEASED QUAN7ETYRELEASED <br /> �SOLID ]LIQUID 'GAS ElSOLID [11i.IQUID GAS_ 1125 gallons <br /> ENVIRONMENTAL OOPMM MAT1ON Waste Water .ITMEOF RELEASE DURATIOM OF RELEASE <br /> OAIR O MTI4R EGROUNDU01HER 8 : 45 a .m , 0 4 30 <br /> i-DA1�S�I�OUi�S—NIIPiU <br /> ACTIONS TAKEN <br /> Shut off the leaking pump and switched to an alternative pump . <br /> Remediated remaining sodium hydrOXi e on the pump rnozn floor with <br /> vinegar_. <br /> KNCMN OR A"C€PATED HFALFH EFFIMTS (idle1hecoma njzse(Ipnbraddtnin%ffmtiot� <br /> ACUTE OR IMMEDIATE*Plain)Harmf.ul if swallowed, inhaled or absorbed tRroug skin J <br /> CHRONIC OR DELAYED(explain) <br /> NOTKNOVW (expiate <br /> ADVICE REGARDING MEDICAL ATTEf 7MON NECESSARY FOR EXPOSED ENDIV1DuALS <br /> N/ A <br /> COMMENTS (INf-MCATF cc--570N A ^)AND 17EM V'A-VK COMMEND ORADDITIONAL INFORMATION) <br /> A <br /> CERTIFICATION: Icerfify uxlerpenaiEy of lawth3t I Face PewnW examined and 1=famdiafwith the inFormatiort <br /> I srr�flted andbeGeve.tl�ss$mted uifo[nxatmn istrf and Iete_ <br /> 12EPOI?TIPIG FACILl I�PRESENTA1nVE (pint ortM <br /> 8IGNATLURE OF REpc)kTfNG FACtLIT�f REPRESENTATIVE pqT� 1 ,2 <br />