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ENt—AGENCY RELEASE FOLLOW-UP NOTI(,_ RECEIVED <br /> SAN OAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> BUSINESS NAME FACILITY EMERGENCY CONTACT&PHONE UPRI 9 2014 <br /> J.R. Simplot Company ( 209)858-2511 ENVIRONMENTAI <br /> $ TIME VICES <br /> INCIDENT MO DAY R OES OES <br /> DATE 07/28/2014 NOTIFIED 1814 (use 24 hr time) CONTROL NO. 14-4223 <br /> INCIDENT ADDRESS LOCATION CITY/COMMUNITY COUNTY ZIP <br /> 833 E 8'Street I I Stockton I San Joaquin 95206 <br /> CHEMICAL OR TRADE NAME (print or type) CAS Number 1336-21-6 <br /> Aqua Ammonia Solution 12- 5% <br /> CHECK IF CHEMICAL IS WSTED IN CHECK IF RELEASE REQUIRES NOTIFICATION <br /> 40 CFR 355,APPENDIX A ❑ I UNDER 42 U.S.C. SECTION 9603 a ❑ <br /> PHYSICAL STATE CONTA INED PHYSICAL STATE RELEASED QUANTITY RELEASED <br /> ❑ SOLID ® LIQUID ❑ AS ❑ SOLID ❑LIQUID ®GAS 5.7 lbs <br /> ENVIRONMENTAL CONT IMINATION TIME OF RELEASE DURATION OF RELEASE <br /> ®AIR ❑ WATER❑GROUND❑ OTHER 11 1814 0 DAYS 1 HOURS 30 MINUTES <br /> ACTIONS TAKEN <br /> Leaking vent removed and pli ig put in place to stop leak <br /> Rail car to be returned to JR I implot Lathrop to be offloaded <br /> E <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS(Use the comments section for additional information) <br /> ❑ ACUTE OR IMMEDIA (explain) <br /> F ❑ CHRONIC OR DELAY (explain) <br /> ® NOT KNOWN(explain) Ainimal release therefore no anticipated health effects <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> N/A <br /> COMMENTS (INDICATE SECTION(A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) <br /> Initial report to agency indicat d higher volume released. <br /> j CERTIFICATION:I certify unde penalty of law that I have personally examined and am familiar with the information submitted and <br /> Believe the submitted informatioi is true,accurate,and complete. <br /> REPORTING FACILITY REPR SENTATIVE(print or type)Brian Crets <br /> SIGNATURE OF REPORTING ACILITY REPRESENTATIVE DATE: �a�- aur is <br /> Ce�r f �d <br />