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m_:T Lineage <br /> II Form <br /> Incident Reporter Details <br /> Name of Person Completing Report: <br /> Danielle Bockman - Facility Quality Control Supervisor <br /> Incident Details <br /> Facility Information <br /> Facility Name: CA, Stockton - PRW Date of Accident: 04/09/2021 <br /> Cost Center#: CC_100125 Date Reported: 04/09/2021 <br /> Facility Address: 2323 Port Road A Time of Accident: 05:00 AM <br /> City:Stockton <br /> State/Province/Territories: <br /> Zip/Postal Code: 95203 <br /> Country: US(United States) <br /> Type of Report: PSM <br /> Did this incident involve Material Handling Equipment(MHE)?: No <br /> Accident Description <br /> Manager/Supervisor Statement <br /> Describe what happened: Ammonia release due to gland packing nut failure. <br /> PSM Incident Investigation <br /> Primary Source of Incident: Manual Valve Contributing Factors: <br /> Describe Other: Not applicable. Equipment Defect/Malfunction <br /> Describe Other Contributing Factors: Not applicable. <br /> Total Quantity of Ammonia Released(lbs.): 7.7 Duration of the Release(approximately): 40 minutes <br /> North American Industry Classification System On-Site Impacts: None <br /> (NAICS):493120: Refrigerated warehousing and <br /> Known Off-Site Impacts: None <br /> storage <br /> Page 1 of 5 <br />